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Working or disabled??? Working or disabled???

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Unread 04-15-2003, 09:41 AM
Working or disabled???

I am currently going through the process. I applied because of other health conditions, and now I have this to deal with on top of it. I can tell you the process is grueling, and your whole life history is laid out on the line. My father was injured in an accident, crushed under a two ton street sweeper. Every bone in his body microscopically crushed. 11 surgeries to correct damage, and it took 3 years and 2 different lawyers to get his approved. On the other hand, I know people with dx of depression that were approved immediately. So, who knows? I do know that the more detailed info your Doc is willing to give up, the better chance. I will keep you updated on the process. But my opinion is that if you need it, go for it.
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Unread 04-15-2003, 10:48 AM
Working or disabled???

I just don't know if I am up to the scrutiny and paperwork right now. I feel under the microscope already due to situations with my ex. And then to take the chance (which seems to be a big one) that they will say "no, you aren't as sick as you claim to be." Just seems like it would be more than I could handle right now.

My mom is on it for chronic hypertension and she didn't seem to have that hard of a time getting it. Also, DBF's ex was/is on it for "mental illness" and got it her first time out. So, who knows....guess it just all depends on how the cards fall.

Good luck to any of you that are going through it.
Unread 04-15-2003, 04:02 PM
Working or disabled???

I am currently going thru the *mental process* of all the *if's* of filing for Disability. For me personally, there are some more downfalls that could potentialy arise from this. Like ((Lenee)), I do have LTD benefits I elected on my Ins coverage. I had also elected for my LTD benefits to be pre-taxed so if the time comes, It will be tax free
Chronic Pelvic Pain, Adhesions, Endo, FMS, Chronic Fatigue Syndrome all fall under Disabilities!!
There is also a Lady who runs an organization fight for womens rights, she has a bill trying to be passed so that Stay at home Mom's/homemakers will receive SS credits...
In my mental turmoil over this desicion for me, I have Researched I have had to work as well thru out this entire time will fighting many illnesses & conditions along with some relief for my pain. It takes everything out of me just to make it thru the day. I live for my days off..I just dont know how much longer I can do this:cry: My GP mentioned this to me a year or so ago, I laughed at the I've been at my current job for 15 years, worked my way to the top, have always been the *Care-Giver*...I refused to ever be dependant on anyone. Then he has mentioned this 3 more times over the past couple months w/ the way I feel it has been getting harder & harder to just get out of bed.
Anyhow, here is what I've come up with:

Disability_ benefits:

1._ Initial application - Every claim for disability benefits begins with the initial application. 75% of all applicants are denied at this step._ SSA looks for a reason to deny benefits._ The decision is based on forms you completed and medical records, you won't meet with anyone involved in making the decision._ It is surprising when anyone wins at this step._ Don't quit--You must appeal a denial within 60 days.

2._ Reconsideration - The second step in the system but the results are worse._ 82% of all applicants are denied at this level._ SSA reviews your file again and issues a denial, unfortunately it may take months to receive._ At this step, only 50% of the original applicants are still in the system, the rest gave up._ Appeal the denial immediately. Up to this point in the system you have been a social security number and a file._

3._ Request for Hearing before Administrative Law Judge - Congratulations! You have persevered in the system and now have a good chance to win benefits._ 53% of all claimants win at this stage!_ Why?_ Primarily because your claim is entitled to a de novo or new review by a Judge who knows the law and does not work for SSA._ Also, you get to testify before the Judge about your inability to work and she/he assesses your credibility._ Finally, hopefully you have obtained opinions from your doctors about your inability to work._ You must win your case at the hearing stage; if you do not, you can appeal but your claim will be tied up perhaps for years with the likelihood of success dramatically reduced.

Increase your odds of Winning:

Now that you have an understanding of how the system works, here are some tips on how you can_ maximize your chance for success.
1._ Appeal every Denial - It bears repeating, DO NOT QUIT after receiving a denial._ Now you understand you must get to a hearing._ Up to that point SSA and the odds are overwhelmingly against you - receiving a denial may be cause to celebrate because you’re a step closer to a hearing.
2._ Retain a Disability Attorney - Retaining an attorney who specializes in disability law should substantially increase your odds of winning._ Most claimants have no idea what they need to prove to win their case._ Practically all disability attorneys work on a contingency fee - you only pay a fee if you win your case._ Also, Federal law sets the maximum amount the fee can be in your case._ An attorney will develop your case by obtaining the necessary medical and vocational records and opinions from your doctors that are critical in proving disability._
3._ Completing Social Security Forms - You will complete a dizzying array of forms requesting all sorts of information._ Be honest and very brief when completing forms._ You won't win your case with the information you give on the forms but you could lose it.

4._ Involve your Treating Physician - Your treating physician is critical to success._ Judges give a treating physician's opinion regarding a patient’s disability tremendous weight._ If your physician is not sympathetic to your claim you may want to make a change to one who is. The purpose of this article is to convey hope that you can win your case and obtain benefits with perseverance and knowledge of the system._ Please do not give up. . . appeal and keep fighting!
Disability Benefits, Fibromyalgia and CFIDS:_
What you don't know could be fatal to your claim!

In my last article I analogized obtaining social security disability benefits based on any disease or ailment to the epic battle between David and Goliath._ Unfortunately, obtaining disability benefits based on fibromyalgia (FMS) and/or CFIDS sometimes can be similar to David versus Godzilla._ In my last article I analogized obtaining social security disability benefits based on any disease or ailment to the epic battle between David and Goliath._ Unfortunately, obtaining disability benefits based on fibromyalgia (FMS) and/or CFIDS sometimes can be similar to David versus Godzilla._
Why?. . in part due to a lack of education at the social security administration (SSA) and human bias against claimants who appear to be "healthy" compared to those afflicted with a more understood and obviously disabling diagnosis. Indeed, I must confess that three years ago I had never heard of fibromyalgia._ However, the good news is FMS and CFIDS claimants can and do obtain benefits with_ proper preparation of their case coupled with an understanding of how the system may view them._ TAKE A DEEP BREATH AND RELAX!!!_ Before you call SSA to give up, please read on, as this article will give you important (maybe critical) information to use in your pursuit of disability benefits. As a disability attorney who concentrates on representing those with FMS and/or CFIDS, I find two things interesting about my clients; most are very educated about their disease(s) while others have never heard of a tender point._ Second, almost all have great difficulty explaining to family, friends and other people (they could care less about!) that even though they appear "healthy," in fact, the diseases have left them debilitated._ Many feel as if their disease and the resulting limitations are often not taken seriously._ Undoubtedly, every client has experienced the look of disbelief and a raised eyebrow from another person when trying to tell him or her the diseases has literally ruined their life. Thus, similar to the real world, it is not surprising that at the SSA the problems of education and bias can be alive and well._ This reality is of paramount importance._ Why?. . Because it should dictate how one proves they are disabled._ Please understand I am not saying SSA discriminates, intentional or otherwise against FMS and/or CFIDS claimants; but rather that your claim (especially if under 50 years old) may be viewed by SSA or an administrative law judge (ALJ) with a raised eyebrow. FMS and/or CFIDS are no strangers to SSA and ALJs who decide whether you are disabled; however, that doesn't mean they understand or appreciate the diseases._ In what may be considered the landmark FMS disability case, Preston v. Secretary of Health and Human Services, 854 F.2d 815 (6th Cir. 1988), a Federal Court of Appeal unknowingly provided a framework within which SSA and ALJs should evaluate FMS (and logically CFIDS) disability claims._ In May 1997, 9 years later after working at bureaucratic breakneck speed, a Regional Chief Judge issued a memorandum to other ALJs which provided a framework to follow at a disability hearing before a diagnosis of FMS is accepted._ Although the following will focus on FMS I believe it can also apply to CFIDS._ Ignoring these factors could be fatal to your claim._
They are as follows: 1. Was the diagnosis made by a rheumatologist or other specialist familiar with FMS? I am always surprised (and skeptical) when a person calls or comes to meet with me and says they have FMS and/or CFIDS but it was not a rheumatologist or other specialist who made the diagnosis._ Other medical doctors can and do make the diagnosis of FMS, but many use the terms FMS/CFIDS generically and more as a description of a patients' symptoms rather than making the diagnosis following the American College of Rheumatology's (ACR) 1990 Criteria for Fibromyalgia or using the CFIDS Centers for Disease Control criteria. If you learn one piece of information from this article, let it be this: It is critical your diagnosis is either made or confirmed by a rheumatologist or specialist._ If not, you risk having SSA and/or an ALJ rejecting the diagnosis altogether, which could be fatal to your claim._ Whether or not you (or your diagnosing doctor) agree with SSA's position, it is senseless to try to fight the system._ Addressing this issue is always my first priority in representing a FMS/CFIDS client. Second, if a rheumatologist has not made the diagnosis, find one (a.s.a.p.!) who is board certified and sympathetic to your diagnosis and disability claim._ Eventually, you or your attorney will need to obtain opinions from him/her regarding how the diagnosis was made along with your inability to work._ An unsupportive and/or uncooperative rheumatologist (or any treating physician for that matter!) can create real and sometimes insurmountable obstacles to winning your case._ Why?. . . because you can bet SSA will_ have its own doctor who will tell the ALJ you are able to work._ How do you find a supportive doctor? FMS/CFIDS support groups are a good place to find a referral._

2. Whether the claimant's physician(s) systematically attempted to eliminate other diseases before making the diagnosis of FMS? A frequently heard comment made by non FMS specialists, SSA case workers and even federal courts is that "FMS is a diagnosis made by exclusion of other diseases."_ Of course, the implication is that doctors really don't know how to diagnose FMS and that somehow invalidates the fact the disease exists._ Such a belief shows unfamiliarity with the ACR 1990 criteria for diagnosis._ However, it reinforces why a specialist should make the diagnosis after a physical exam (finding and documenting tender points) and blood work excludes other rheumatic diseases which may share symptoms with or mimic FMS/CFIDS._ That process provides validity to the diagnosis._

3. Whether the patient's complaints are typical for the disease? This question is usually answered by reviewing the patient's medical records and comparing them to the ACR criteria._ Hopefully, the medical records provide detail regarding the patient's symptoms or complaints._ FMS/CFIDS specialists almost always document the defining symptoms._ For FMS patients it is also critical that a physical examination was performed confirming the existence and location of the classic tender points._ Without documentation, the diagnosis may be subject to attack._ _

4. Whether the claimant was referred to physical therapy or a pain clinic for treatment,_ whether pain medication was prescribed for mild or severe pain and whether the_ claimant received pain relief through injections into focal tender points? The "exhaustion of remedies requirement."_ I always counsel clients to undergo and at least try any treatment the specialist prescribes, including non-traditional treatment._ Why?_ Because you do not want to be at a hearing before an ALJ who is wondering whether your condition would be as severe if you had followed your own doctors' instructions._ Moreover, SSA's doctor will usually tell the ALJ that your symptoms would improve (of course, allowing you to work) if you would undergo some type of treatment._ Don't give the ALJ an open door to deny your claim._ Exhausting each type of prescribed treatment is good for your health and your disability case._ After doing so, your testimony will be more credible because nothing exists (including an injection!) to alleviate the severity of your symptoms._ Moreover, the severity of your condition will be supported by the fact that you have tried everything to find relief._ Trying to stay within the framework provided by the Preston case should increase your odds of winning and avoid any unfortunate surprises. Additional tips to keep in mind: Involve your treating physician!_ Tell your doctor as soon as possible you have filed a disability claim._ If he/she is lukewarm to the idea, try to find another doctor._ Unfortunately, there are many doctors who could care less about a patient's legal issues._ Do not get stuck with one!_ As an attorney, nothing is more frustrating than a doctor with no backbone or worse, he/she refuses to be involved at all._ Medical records can be your best or worst friend!_ It is your job to be a very detailed historian with your doctor regarding the severity, frequency and nature of your pain, fatigue and other symptoms._ I tell clients to convey information regarding pain, fatigue, sleeplessness, flare ups, days spent in bed, inability to do simple daily activities and brain fog problems._ Tell the doctor you want the information in your records. Hire an attorney who has experience handling FMS/CFIDS cases!_ During initial meetings with FMS/CFIDS clients I sometimes say to myself_ "If I didn't know better, I'd say this 40 year old woman looks perfectly capable of working!."_ It is only through an understanding of the diseases and talking to clients that I realize they will pay for the trip to my office for the next couple of days!__ Through understanding comes compassion and the ability to convey the effect the diseases have on a client's life to SSA or a judge._ Your attorney should at least be familiar with the 1990 ACR and/or CDC criteria and be able to talk intelligently with your doctor.
**Remember: people obtain disability benefits every day based on FMS/CFIDS**.

_ Do not quit! Keep fighting!_ Use this article as the cornerstone to preparing and hopefully winning your case._
Helping Fibromyalgia Patients Obtain Social Security Benefits:

A physician's evidence and testimony may be the deciding factor in the success of a patient's application for Social Security disability benefits; however, the fact that the reports are signed by a physician will not by itself sway the Social Security Administration. Especially if the disability is related to one of the "new" or sometimes unrecognized disease entities, such as fibromyalgia, a brief unsupported conclusion that the patient is unable to work will likely contribute to denial of benefits. The physician's report must be detailed, complete, prove knowledge of the patient and the disease, and document disabilities (including physical capacities, time duration for various activities, pain, and behavioral factors). Coordination with an attorney may help make the physician's report most effective. (J Musculoskel Med 1992;9(9):65-74) The Social Security system does not easily or quickly rule favorably on a claim of disability. For patients with fibromyalgia and similar disease entities, whose very existence is often questioned, proof of disability is especially difficult. Nevertheless, by following an orderly and logical process, claimants may become eligible to receive benefits ranging between $350 and $1,000 a month until age 65, in addition to Medicare, which begins making payments 24 months following disease onset.When you are convinced that a patient is unable to work at any job, your medical evidence may be the deciding factor in determining whether the disability claim is successful. As the treating physician, your efforts should be coordinated with the claimant and an attorney to establish that, within the Social Security Administration requirements, a period of disability did exist.In this article, I review the claims process, with emphasis on the role of the physician. I discuss the kinds of information you may be asked to provide, the need for clear and objective statements rather than terse opinions, and the fact that the investment of a small amount of your time may be instrumental in your patient's being judged eligible for benefits.WHAT IS DISABILITY?The Social Security Administration test of disability is "An inability to perform any substantial gainful activity because of a medically determinable physical or mental impairment which can be expected to last for a continuous period of not less than 12 months." (1) In Social Security terms, "substantial gainful activity" means work that "(a) involves doing significant and productive physical or mental duties; and (b) is done (or intended) for pay or profit." (1) A person is ineligible to receive Social Security disability benefits if he or she:
Is working (except in a "sheltered" setting), even though chronically ill
At present has the statutory ability and capacity to work
Recovered within 12 months of the onset of a disabling illness
Has no medically determinable impairment (except for one of the somatoform disorders, which are considered under a separate set of rules) (2). <B>THE PROCESS BEGINSThe sequence of actions usually necessary for a person -even one who clearly appears disabled - to obtain disability payments is shown in the Table: Table - Steps in the process of applying for Social Security Administration disability benefits


Initial application Filed by patient
Request for reconsideration Filed by patient within 60 days of initial rejection*
Chart copied Information about patient supplied by physician at the request of Social Security Administration
Physical examination Performed by Social Security Administration physician
Request for hearing Filed by patient within 60 days of rejection of request for reconsideration
Chart update, report Supplied by physician
Trial A new determination; attorney and physician participate
Appeal Filed by the attorney with the Appeals Court within 60 days
Suit Filed by the attorney with the United States District Court within 60 days (Attorney must have license to practice in District Court.)

*If the 60-day time limit is not met, the process is ended and a new application must be filed.
Physicians should advise every patient of the option to file for Social Security disability benefits when that patient has not been able to work because of illness for 12 consecutive months. Indeed, an application may be filed as soon as it appears that the duration of disability will exceed 12 consecutive months. Often such a prognosis may be made within 6 months of disease onset, and at that time the filing process for Social Security disability benefits should commence. A person who has worked and paid Social Security taxes applies for Social Security Disability Insurance ("Title II"), and a person of limited income and resources receives disability benefits through Supplemental Security Income ("Title XVI").Claims for Social Security disability benefits are made at the local Social Security District Office, either in person or by telephone (800-772-1213). Initial filing - which asks about the nature of the disease, name of the physician, and vocational background - is made by the claimant; physicians and attorneys are not involved at this time. It is the filing of a claim that alerts the government to a person's inability to work.Once the initial claim is filed, the Social Security Administration gathers by separate inquiry three types of information:
Medical - initial description of medical condition, including capacity for lifting, walking, sitting, and standing (3)
Vocational - description of past work; date last worked
Administrative - proof of citizenship and, possibly, insurance status A response by the Social Security Administration may take as long as 6 to 8 months. The application will be analyzed by both a nonphysician and a physician who review medical and vocational issues for the Social Security Disability Determination Services, a state agency that works under a contract to the Social Security Administration. (4) The physician-reviewer is usually not a practicing clinician and may have had no training or experience in the medical field under discussion.Initial applications for disability benefits are routinely denied, and your patient should be prepared for initial denial. The language used by the Social Security Administration is consistent regardless of the details of the particular case, with no flexibility for individual situations. The denial usually observes that the claimant appears to be able to move hands and arms and to stand, but leaves open the possibility of reapplication if the patient's condition worsens.<B>APPEALSAn appeal of the initial unfavorable determination must be made to the Social Security Administration within 60 days of its mailing. This time limit is jurisdictional, which means that Social Security will not have a legal basis to hear the matter if the filing is late. The appeal, which is not a new application, is called a "request for reconsideration." The filing may be made at the Social Security Administration District Office or through the offices of an attorney who practices in that field. The attorney will charge 25% of back benefits - moneys that would have been received if payment of benefits had begun at the onset of illness - and may not by law charge or receive a fee without approval by the Social Security Administration.The request for reconsideration triggers a request for additional information about the disease, medical providers, and treatment. Information about undisclosed impairments is invited, and questions about activities of daily living are posed. The physician is requested to submit the patient's medical chart, but is not apprised of the rules and criteria for disability.Following a request for reconsideration, the claimant may be referred for an independent medical examination by a physician under contract to the Social Security Disability Determination Service. Frequently, waits are long, examinations are brief, and medical records are not available for review by the Social Security Administration physician, who is paid approximately $88 for the examination and report.The examination data are reviewed in the same manner as the initial application and, again, denial of benefits is the usual result. There is no requirement that Social Security act on a request for reconsideration within a given number of days. (For example, in California, the wait is approximately 7 months.The denial usually contains suggestions for alternative work possibilities, which may bear no relationship to the applicant's work history or experience. The job titles offered may include such examples as coil winder and doll stuffer; the titles are found in the Dictionary of Occupational Titles. The claimant should be aware that the suggestion does not necessarily have to be acted on but, rather, should be considered merely as a step in the process of obtaining disability benefits.<B>REQUESTING A HEARINGFollowing denial of the request for reconsideration, a "request for hearing" may be filed. This is an appeal of a prior unfavorable determination, not a new application. Filing must be within 60 days, which is jurisdictional. The request for a hearing will result in a trial before an administrative law judge, probably within 4 months of filing the request. The trial is a new determination, wholly independent of the previous administrative decisions. It is at the trial level that experts in forensic medicine and trial advocacy are needed.At the hearing, which is evidentiary (oral and written evidence is used), the patient is given an opportunity to testify regarding symptoms, past work, and residual functional capacity. The physician should provide a narrative report, after reviewing the chart and the Social Security Administration criteria for disability. For this hearing, the medical provider and attorney must work in close cooperation. The judge usually does not have the background to be able to extract from the medical evidence a finding of disability, and will be guided by clear forensic medical reporting and by testimony by the patient. If the trial results in a finding that the claimant is not disabled, an appeal to the Appeals Council may be made within the jurisdictional 60 days. The Appeals Council decision, usually issued within 7 months, is likely to affirm the decision of the trial judge. An unfavorable Appeals Council decision may be appealed by filing a suit in the United States District Court. This is an area of great legal complexity, and an attorney must be licensed in order to appear in District Court. The District Court may reverse the decision of the administrative law judge, but more frequently it returns the matter for a new hearing (a remand). This trial is based on the initial application filed in the district office, which clearly should be as complete and correct as possible. It is not uncommon that 2 years will have elapsed between the initial application for disability benefits and the district court ruling. All the while, the Social Security Administration has provided neither stipend nor payments for Medicare to the unemployed claimant.<B>THE ROLE OF THE PHYSICIANThe physician's role in the application process is shown in "Steps for the physician assisting in a disability claim."** The key to a successful disability claim is the medical report. However, success ultimately arises out of the mix of medical evidence, law, and testimony. Seldom will disability benefits be granted if any of these elements is deficient.Establishing a medically determinable condition is the shared province of the treating physician, the attorney, and the patient. Case law and regulations require clearly articulated medical findings. The administrative law judge faces a heavy burden to disregard the opinion of the treating physicians on all issues save the ultimate issue of disability.Occasionally a judge disregards the opinion of the treating physician, and that decision is likely to be overturned on appeal. Other judges follow proper procedure and practice and base decisions on the physician's testimony. The quality of the medical chart and report is, thus, of extreme importance. (6)Physicians who wish to assist their patients in establishing disability must become familiar with the body of regulations that the Social Security Administration uses to evaluate medical conditions. These rules are known as the "Listing of Impairments," (7) which constitute a keystone in the disability process. The listing is contained in the booklet "Disability Evaluation Under Social Security," available from the Office of Medical Evaluation of the Office of Disability, SSA, 6401 Security Boulevard, Baltimore, MD 21235. This office is the source of all Social Security information pertaining to medical issues. There is no specific listing for fibromyalgia or many of the other diseases that have gained recognition recently or whose existence as a disease is under debate. This, when assisting a patient disabled with such a disease, physicians should consider whether any other listed criteria apply. For example, chronically ill patients who are afflicted with fibromyalgia frequently manifest many of the criteria for psychiatric disability (listing 12) or have somatoform disorders (listing 12.07). (6) Basing an appeal on one of these criteria may be inelegant but appropriate.When a patient meets the qualifications of a listing and the treating physician provides only a conclusion of disability, unsupported by the medical record or factual bases, failure to attain disability status is assured.


Disability claims that arise from diseases such as fibromyalgia mandate the most scrupulous and detailed medical charting, if the application for benefits is to succeed. Chart entries for fibromyalgia and similar diseases often are brief and incomplete, reflecting the poor doctor-patient relationship with these patients, who may be impatient for relief and disillusioned with physicians. A hastily written chart note will not support a physician's later statement that a patient is unable to sustain regular and substantial employment. Even the structured "symptoms, observations, assessment, plan" (SOAP) format is inadequate to convey the sequelae of a complex disease such as fibromyalgia.When a physician recognizes that a patient may become a candidate for Social Security disability payments, chart entries should be made in detail. Not only are height, weight, and blood pressure essential elements in charting, but also adaptive reactions, physical capabilities, and functional deficits must be noted.Every patient visit should result in entries concerning physical capabilities for lifting, bending, and carrying (verified with measured weight); time durations for sitting, standing, and walking (by history); psychosocial and adaptive behavior, including the ability to interact appropriately with others, follow instructions, and adhere to a regular schedule; and the complex of depressive symptoms. Although this may seem to be a heavy reporting burden, with a properly designed chart this information can be quickly set forth. At a trial, the value of such a contemporaneous and complete record is immeasurable.<B>PAST WORKIn gathering reports for a Social Security Administration disability claim, the focus must be on establishing the presence of a medically determinable condition that prevents substantial gainful employment. Substantial gainful employment has two aspects: past work and all other work. Essentially, to be found disabled, a person must be not only incapable of performing past relevant work but also unable to perform all other work (the rules change for persons over age 50). Although this requirement may appear to be an insurmountable barrier, disability can be demonstrated with consistent, accurate, and complete medical reporting.Almost any employment requires regular attendance, the ability to concentrate and follow instructions, and appropriate reactions to supervision. Postural requirements such as walking, lifting, and standing are also considerations. A Claimant's case is greatly furthered by a report that reads: "Patient's past work required sitting all day, analysis of complex data, and lifting to 10 lb. Now the patient can sit a maximum of 20 minutes, cannot concentrate because of medications and pain, and is always exhausted because of lack of sleep. Patient is irritable, argumentative, and misses appointments. Measured lifting is now to 3 lb. Cannot and should not work..." Such a notation provides the attorney the opportunity to develop testimony at the administrative hearing. Conversely, a notation of "complains of pain, treatment continues" virtually guarantees nonpayment of a claim to Social Security for disability. Diseases with a profile of alternating acute and remissive states should be reported in their totality, and the temporal relationship between acute and remissive status noted in the chart. The Social Security Administration has been known to deny a claim of disability because the 12-month duration requirement was not met as the result of 1 month of improvement during the seventh or eighth month of illness. <B>NARRATIVE REPORTAttorneys often request the treating physicians to prepare, for the hearing, a narrative report, which is central to the development of the claim. This report is most effective when the legal issues to be discussed are identified by the attorney.The narrative report should follow the familiar forensic format:

History - a description of work history, demonstrating familiarity with the patient's past work, including its physical and intellectual demands

Examination - reference to the patient's medical chart, including a report on pain and the side effects of pain medication; an assessment of mental health; a report on measured physical capacity (capacities based on regular, sustained effort); physical findings, including reference to tolerance for sitting, walking, and lifting

Discussion - a review of objective physical test results and clinical observations; a discussion of pain, specifying the activities that exacerbate the pain; support for your prognosis accompanied, where applicable, by an indication that you have seen many similar cases and are familiar with the pathology of the disease; assertions, if true, of your expertise in this field that the complaints are credible, and that the patient is not malingering or seeking secondary gain; as well as a statement strongly conforming the diagnosis and stating that the symptoms are consistent with the signs and diagnosis.A complete narrative forensic report supported by a good chart need be only two to three pages long, requiring perhaps a half hour of dictation. This report can make the difference between a rejection of the claim of disability and thousands of dollars of needed benefits for your patient. IN-PERSON TESTIMONYTestimony from a treating physician greatly increases a patient's chance of success at the disability hearing. An administrative law judge gives serious consideration to live medical testimony, especially when deciding about a disease, such as fibromyalgia, that is not yet on the list of impairments. Testimony is most effective when supported by a complete and detailed chart and when the testifying physician has a clear understanding of the Social Security system, the formalities of disability proof, the relationship of age to the listed disorders, and vocational considerations. Careful preparation with the patient's attorney is required for the testimony, which is likely to take a half hour. Judges often accommodate a physician by allowing testimony out of order, thus speeding the process. Not every case, of course, calls for live physician testimony. The attorney is best able to make such a strategic assessment.DISABILITY ECONOMICS:
Social Security disability benefits range between $350 and $1,000 per month, and Medicare begins 24 months after onset of disease. (8) The amount of Federal Insurance Contributions Act (FICA) tax paid by the patient while employed determines the amount of benefit.In my experience, persons who claim disability due to fibromyalgia are typically bright, articulate women who have excellent earnings records. Past work is usually in middle to upper management and is generally well-paid for the geographic location. Because such patients have had high FICA payments, they will likely receive $750 to $1,000 per month until age 65. At that time, the disability payment comes from regular Social Security retirement, without penalty for early retirement or quarters of no income subsequent to the onset of disability. In addition to ongoing monthly benefits, most fibromyalgia patients receive substantial retroactive moneys. Social Security benefits begin with the sixth month following the cessation of work activity. The first 5 months of benefits are retained by the government as a "waiting period." It is not uncommon for more than 24 months to have elapsed before a favorable determination.Because of delays during the filing process, early recognition of disability and early filing are important: disability benefits are payable as of 1 year before application; Supplemental Security Income is payable from the application date. ** Steps for the physician assisting in a disability claim:
1. When it becomes clear that the patient will be unable to perform any work for at least 12 consecutive months, suggest that the patient apply to the Social Security Administration for disability payments.
2. Make sure that all entries on the patient's chart are complete and detailed.
3. Once the application and appeals processes have been exhausted and a hearing is scheduled, work with the patient's attorney to prepare a narrative report on both the patient and the illness causing the disability.
4. Prepare, with the attorney, testimony to be presented in person in court.

My question is the following :
Having Fibro as she has, can Fibro keep her totally disabled for the rest of her life? Have you ever heard big health improvment?

Answer: In its worst form, fibromyalgia can be associated with significant disabilities. After muscular injuries, some can develop what is called "post-traumatic fibromyalgia." These patients can improve with the use of various medications, physical therapy and learning what activities cause greater problems so as to try to avoid them. Sometimes, the improvement may take a significant amount of time. The most important part in terms of trying to find a curative approach is that of maintaining a positive attitude and trying to find a supportive health professional with a similarly positive attitude toward the overall treatment plan.

Question: My friend has chronic pain from fibromyalgia to the point that he cannot lift his arms and extreme pain of muscles in the limbs and lower back. He works at a normal pace then faster as the pain increases. at the day's end he has no strength left to fight the pain. What can be done to lessen the pain for the sake of mental health and sanity?

Answer: Firstly, when muscle pain and weakness are noted in FM, one needs to make sure that another possible cause such as myositis or other primary muscle disease is present. This can be done with the help of your doctor. He will need to check some of the muscle enzymes and may need for your friend to see a neurologist to rule out the presence of a possible muscle disease.Assuming that this is not the case, then considering the use of low doses of tricyclic antidepresent medication may lessen the pain and help to treat the underlying FM problem

Applying for Disability Benefits

Fibromyalgia syndrome (FMS) is a chronic pain disorder that causes widespread pain, tenderness, and stiffness in muscles, as well as general fatigue.It's Tough, But Can Be Done UNDER the current disability claim process, people with fibromyalgia syndrome (FMS) who apply for United States Social Security disability benefits face a struggle. According to Joshua Potter, an attorney specializing in representing clients seeking disability benefits, "The process can take a long time, but you've got to remember not to give up, not to abandon your application, and most important: don't start over again."
If you care about someone with FMS, or you have fibromyalgia, this article will provide you a general overview of the application process for Social Security disability benefits. It is not intended to provide legal advice.

Deciding to Apply Beginning with the decision to apply, a person diagnosed with fibromyalgia, and his or her family, must prepare to answer some difficult questions

1. Is the person eligible? In order for a person to qualify for Social Security disability benefits, the person must have worked long enough and recently enough under Social Security.

2. Does the person qualify for disability? A person is considered disabled if "you are unable to do any kind of work for which you are suited and your disability has lasted or is expected to last for at least a year or to result in death."

3. Can the person handle the physical and emotional demands of applying for disability? "Making the decision to seek government financial help and struggling through the claim process will be physically and emotionally difficult."
In order to make the process less difficult, talk with your loved one and address concerns either one of you may have. Inquire how you can be supportive. Ask other knowledgeable people (such as an attorney, support group leader, trusted friend, and so on) for their additional support and encouragement.

4. Can the person live on no income for a year? The claim process can take several months or even more than a year. A chance for disability benefits is diminished if the applicant earns more than $500 a month. Receiving income from a pension or other disability payment may also affect the applicant's claim. In addition, if fibromyalgia symptoms are severe, the person may have to cease work entirely and rely heavily on a spouse, partner, family or friends for financial support. Although it may an uncomfortable subject to discuss, the person with FMS and his or her family should address concerns about resources and create a financial plan.

5. Does the person have the stamina to deal with a lengthy claim process? Filing a disability claim and following it through can be overwhelming to a person with fibromyalgia. Pain, fatigue, difficulty with concentration, and short-term memory loss, are all symptoms that get in the way. Your loved one may need your help and the help of friends, relatives, health care providers, an attorney, and support group members. Electing a specific person to act as an advocate for the applicant may be a necessity, and should be taken into consideration.

Where to Begin If your loved one decides to apply for Social Security disability benefits, preparation for the claim process should begin as soon as possible. Offer your support to your loved one to help accomplish the following tasks:

1. Become educated about the process of filing a disability claim (see resources listed at the end of this article)

2. Make an appointment at the local Social Security Administration (SSA) office to obtain up-to-date information about the claim process. During the visit obtain several copies of the necessary disability claim forms. If a SSA office is not located nearby, call Social Security's toll-free number, 1-800-772-1213, or visit the Social Security website,

3. Enroll the help of healthcare professionals. Doctor reports and medical tests are two important pieces of evidence used to determine whether or not the applicant qualifies for disability. Every office visit should include a report from the patient, or a test by the doctor, of the patient's diminished ability to perform basic functions—standing, sitting, lifting, walking, carrying—problems with memory and concentration, problems with medication, and anything else that may be pertinent

4. Decide whether or not to hire an attorney who specializes in disability issues. The National Organization of Social Security Claimants' Representatives (NOSSCR) refers people to private attorneys specializing in Social Security claims law

5. Start collecting and organizing the necessary evidence

The Needed Evidence
The determination of disability benefits takes longer to process than other Social Security benefits, approximately 60 to 90 days. "It takes longer to obtain medical information and to assess the nature of the disability in terms of your ability to work.
However, the length of time can be shortened by providing the documents and information listed below
• The Social Security number and proof of age of the person applying for benefits

• Names, addresses, and phone numbers of doctors, hospitals, clinics, and institutions that treated the person and dates of treatment

• Names of all medications the person is taking

• Medical records from the person's doctors, therapists, hospitals, clinics, and caseworkers

• Laboratory and test results

• A summary of places where the person worked in the past 15 years, the kind of work done, and a description of the major physical and mental demands of each job

• A copy of the person's W-2 Form (Wage and Tax Statement), or if the person is self-employed, a federal tax return for the past year The Social Security Administration denies vague claims more quickly. Therefore, applicants should identify all significant impairments in his or her application. Applicants should also try to submit complete medical documentation at the very time they file their claim papers. If an attorney has been hired to handle your loved one's disability claim, the attorney will also be able to help gather the necessary information.

What to Expect The SSA processes disability claims in sequential steps. The steps include an initial application, usually followed by a denial, a request for reconsideration, and then a request for a hearing. The process begins when the claim is filed at your SSA office. The process can also start by calling SSA's toll-free number, 1-800-772-1213. Your loved one will be asked the nature of his or her disability, his or her doctor's name, address, and phone number, and the details of your loved one's last job. The SSA will then investigate your loved one's medical history, capacity for lifting, walking, sitting, standing, work history, citizenship, and insurance coverage. This investigation can take several months

Winning a favorable decision means that you get an award within three or four months after filing your claim.
If the claim is denied, and appealed, it can take fourteen-plus months for a final decision on the case. Throughout the disability claim process, it is essential to respond in a timely fashion. When Social Security notifies the applicant of its decision, the applicant has only 60 days to appeal the decision and proceed on to the next step. For more information about appeals, contact Social Security [/quote]

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Unread 04-15-2003, 08:28 PM
Working or disabled???

WOW - thats a lot of info to process and tomorrow I will look at it all. It is very hard to function normally. I know what you mean about living for days off.

I know you can file for disability on line...I don't know - maybe down the road. I keep waiting to feel better but its been 2 yrs now. ENOUGH.

Tomorrow morning I am seeing the pain mgmt dr to discuss my back and then hopefully my neck pain. I know when my back flares up so does the pelvic area as well. So maybe if I attack from the back it may help. Who knows?!
Unread 04-25-2003, 07:25 PM
Working or disabled???

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