Thursday, May 22, 2008



Social Security Disability and Gray Areas

A recent commenter mentioned that her condition is rare (Dissociative Seizure Condition ) and that it falls into a gray area. Her comments made me wonder--Do certain conditions fall into a gray area?

Unfortunately, we are stuck with the "company line", which is social security's line. That would essentially be something along the order of "There is no gray area. All medical conditions are evaluated as to their effect on a claimant's ability to work; that is, on the extent to which they determine a claimant's residual functional capacity, or RFC". Your RFC, by the way, is a measurement of what you can still do, despite your condition and your RFC assessment determines whether or not, in social security's eyes, you can go back to doing your past work, or even possibly do some form of other work.

From the standpoint of the social security administration, there really isn't a grey area because whether a physical or mental condition is included in the blue book, the social security list of impairments, or is evaluated on the basis of sequential evaluation (this where the concept medical vocational allowance comes into play), the decision all comes down to what the records have to say about the claimant's remaining ability to work, i.e. residual functional capacity.

However, having said all this, let me state that I believe a gray zone does exist in this one sense. There are a number of medical conditions, both physical and mental, for which the social security administration (and by this I mean disability examiners, their supervisors, and the doctors who are assigned to their processing units) is not properly equipped to evaluate. And that would include fibromyalgia, RSD, Lyme disease, and a whole host of disorders.





Return to the Social Security Disability SSI Benefits Blog



Other Posts

Social Security Disability List of Impairments
Social Security Disability SSI Status
What does Social Security Disability consider a Mental Impairment?
How many people win Disability Benefits from Social Security?
Social Security Disability Requirements
Will I Qualify for Social Security Disability?
Qualifications for Disability - Social Security (work credits) and SSI
SSI Application for Disability Benefits
Filing for Disability with Fibromyalgia
Qualifying for Disability - How difficult are the Qualifications?
Application for Disability - SSD and SSI applications
Social Security Disability List of Impairments
Application Requirements For SSI Disability
Disability Requirements - The Criteria for Social Security Disability and SSI
How to Qualify for Disability - social security disability or SSI
Are there disability benefits for children?
Social Security Disability Eligibility
Who is eligible for Social Security Disability or SSI Disability?
Correct Steps for Filing a Social Security Disability Claim
Getting Disability - Social Security Disability and SSI
Tips for Filling out a Social Security Disability Application
How Does Social Security Decide Your Disability Claim ?

2 Comments:

OpenID katharinakatt said...

Thanks for going over this. It is very helpful. I do have a follow up question since you say

"There are a number of medical conditions, both physical and mental, for which the social security administration (and by this I mean disability examiners, their supervisors, and the doctors who are assigned to their processing units) is not properly equipped to evaluate."

I was told that I shouldn't explain what 'Dissociative Seizure Condition' is because the Doctors reviewing the case already know what it is and that it is 'insulting' to them to do so.

Personally I didn't find a single doctor in the USA know what was wrong with me. It wasn't until I moved to Europe and the Doctors knew instantly what was wrong with me.

This makes me think that Doctors assigned to review my case in the US will be just as clueless.

So when is it allowable or advisable to 'educate' those working on our case as to what our condition is and entails?

Thanks again! Keep up the great work!

7:13 AM  
Blogger Disability Blogger said...

Re: "So when is it allowable or advisable to 'educate' those working on our case as to what our condition is and entails?"

Personally, I don't think it ever hurts to do this. I'll tell you why. I was a disability examiner and I can tell you honestly, disability examiners don't have medical training. They are trained to read medical records and ferret out information from the records that will allow them to determine whether or not you meet the criteria of either A) a condition that is listed in the impairment listing manual, or B) the sequential evaluation process. If your condition is in the manual (most aren't), then it will simply be a matter of seeing whether or not your records indicate you meet the criteria or not. If your condition is not in the manual, then the examiner will still need to read your records to determine what your functional limitations are, and whether or not you can go back to your past work or do some form of other work. This can be a problem, of course, because most doctors don't write squat about functional limitations in their treatment notes. But regardless of whether your particular condition is listed in the manual or your condition needs to be evaluated using sequential evaluation, its helpful if the examiner actually has some familiarity with the limitations that are potentially brought on by a certain condition. As I said, examiners don't have actual medical training. They are more similar to disability insurance claims adjusters. This may to be some extent the reason why you get such screwy decisions coming out of the various DDS offices around the country. But, of course, you can't blame just the examiners. They have their supervisors to contend with, as well as the unit doctors they work with.

Regarding the doctors who work with examiners, don't assume they know much about a lot of conditions. It's very common for certain kinds of cases to be taken to specific doctors at a DDS simply because the other medical consultants don't feel comfortable evaluating certain kinds of conditions. In the state agency I worked in, nearly all the eye cases were sent over to one doctor because the other doctors didn't feel qualified to evaluate eye cases (and this doctor wasn't even an eye specialist himself either).

To answer your question, its ok to send in information about your condition to educate the examiner. But don't send in a mountain of medical literature. They won't read it and all they'll think is "Oh brother". If you send anything in, try to send a statement from your treating physician that describes your impairment and how it specifically limits your ability to engage in daily activities and to work.

11:32 AM  

Post a Comment

<< Home