A must read for SSI applicants

Discussion in 'Fibromyalgia Main Forum' started by Takesha, May 18, 2003.

  1. Takesha

    Takesha New Member

    I found this on a lawyers website and it is a good one to print and share with your doctor if you applying for SSI.


    Steps for the physician assisting in a disability claim

    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.
    Make sure that all entries on the patient's chart are complete and detailed.
    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.
    Prepare, with the attorney, testimony to be presented in person in court.
    Medical records
    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 capacities, and functional deficits must be noted.

    Every patient visit should result in entries concerning physical capacities for lifting, bending, and carrying (verified with measured weight); time durations for sitting, standing, end walking (by history); the nature, location, and intensity of pain (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.

    In 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. Patent 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 continued" 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.

    Attorneys often request the treating physician to prepare, for the hearing, a narrative report, which is central to the claim: This report is most effective when 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 capacities (capacities based on regular, sustained effort under worklike settings, not on a one-time effort); physical findings, including reference to tolerances 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 confirming 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

    Testimony 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.

    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 usually is 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.

  2. Mikie

    Mikie Moderator


    Love, Mikie
  3. ckball

    ckball New Member

    It is great to see this info, I am in the recondsideration phase now, but will keep this for future reference. Thanks
  4. leokat

    leokat New Member

    I thank whoever that I live in the Uk and by some miracle the disability benefit doctor I saw 18 months ago believed in fibro and cfs.

    Not that it has all been plain sailing nor is there any guarantee that the next doctor I have to see (July) will believe in my illness. I still do not receive all the benefits I believe I'm entitled to and things are very tight financially.

    For all that at least I do receive some money and the fact that my illness IS recognised by the benefit agency has made me feel so much less of a fraud.

  5. sofy

    sofy New Member