Monday, April 20, 2009

Headaches that don't go away, Pain, and Social Security Disability

I've written before about pain and the apparently inherent shortcomings in the U.S. disability system with regard to its ability to properly assign some reality-based measure of influence to pain and how it limits an individual's capacity to engage in work activity. I've also written about my experiences with pain which, fortunately, have been sporadic and acute.

Recently, I've been having some fairly severe headaches, severe in that they are intense, of long duration, and seemingly omnipresent. As in from the moment I wake up till the moment I go to sleep. Though I will see an orthopedist soon, I am fairly certain that the cause of of my headaches has everything to do with being in front of a keyboard and monitor for far too long each day. And by that I mean being rooted to my chair in a fixed position for hours at a time.

As the certified massage therapist I've recently gone to commented, "the human body neither likes nor is adapted to living like a tree".

This post is not about my headaches, however, nor is it about Boston Legal, a show that I've only now gotten to see for the first time on DVD (while I'm on the treadmill at the gym) despite the fact that its been on for years (Shatner is great in this show, so is James Spader who always chooses such interesting character roles).

This post is about insights. Insights that only pain can bring about. And insights that make us realize more fully those things we claim to know. For instance, we claim to know that pain is fatiguing and limiting. All of us, disability examiners and non-disability examiners. But...there's a huge difference between knowing this truth because it seems self-evident...and really knowing it because we are currently experiencing headaches, morning, noon, to night that will not go away.

I was speaking to my wife the other day (currently a social security office claims rep and also a former examiner like myself) and she said, "How can they expect people who have ongoing migraines to go to work?"

She said that...despite the fact that we, as former examiner cogs, know full well that people with chronic migraines are denied for disability benefits all the time. And she said that even though we know full well that the state disability agencies and all the people who work within them have very little empathy for a claimant's pain, and offer very little consideration, in a medical vocational approval sense, for pain in general. Not because they are evil people, mind you. but because the system is not codified in such as way as to allow examiners to give credence to the limiting effects of pain.

Now, what was the basic point I was trying to reach in this post. Ok, this is kind of funny, but, in dealing with my neck and head right now...I seem to have forgotten.

Doesn't matter, though, there's always something of relevance to connect to. Such as this: I think its fairly evident that one huge way in which the disability evaluation system falls down is in the attempt to objectively evaluate complaints for which there's little means to objectively quantify them.

In other words, A) pain is subjective, B) doctors have a weak response to pain, and C) the social security disability / SSI disability system often takes little notice of it.

So, in a system that has, for years, demonstrated an inability to consider claimants as little more than files and cases, a system filled with adjudicators who show little empathy for limitations that result from prolonged (perhaps years-of) pain , how can we expect----

(Here's the big jump from one topic to another; however,if you've read this blog for any appreciable length of time, you'll see that this all connects)

----the federal disability system to improve with things hearings?

Think about it: one of the advantages of going to a disability hearing is that you get to meet, physically meet the decision-maker on your case.

Why is this advantageous to you, the claimant? Well, there are actually a number of reasons why cases do better at the hearing level. Disability examiners and state agencies aren't involved, administrative law judges don't have supervisors, disability representatives get to make an in-person appearance, etc.

But one factor that plays a role is that the adjudicator, in this case a judge, can't completely relegate the claimant and the claimant's case to simply being just...a file. Pretty hard to do when someone is standing there in front of you, in the flesh. Some judges may "act" as if claimants are just bits of flotsam and jetsam, but human psychology really makes it hard to completely ignore another person when they're in the same physical confines. And video hearings remove that advantage.

Return to the Social Security Disability SSI Benefits Blog

Other Posts

Steps to Request a Hearing for a Social Security Disability Claim
Social Security Disability Hearing
Can you get disability benefits if you have never worked ?
The Criteria for Social Security Disability and SSI
If Denied Social Security Disability ...

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Blogger Sheryl said...

Nowhere else in legal land except SSDI hearings. Well, that and some states' bond hearings. Video just can't cut it.

Oh, and I love that quote from your massage therapist. I have to remind myself of that every single day. I finally downloaded this tool that interrupts my computer work every hour on the hour with a full-on stretch break, complete with demonstrated exercises. That does help.

9:18 AM  
Blogger Disability Blogger said...

Sounds like a good tool. My MT recommended something similar: setting an alarm to sound every hour for a stretch break (versus sitting for hours and then, when finally making a turn of the head, hearing a disconcerting crunching sound coming from the neck).

8:47 PM  
Blogger Travis said...

My wife has chronic daily headaches, chronic migraines, atypical migraines, neck pain, shoulder pain, and a few other conditions. She has had a headache 24/7 for 5 years now (now at level 7/10 or higher all the time), and has been unable to work since October of 2008. She has had (unsuccessful) nerve decompression surgery for her headaches, which actually made things worse. When we applied for SSD in November, we submitted a table of more than 30 doctors / specialists that she has seen for this condition over the years -- along with personal medical records and all the records that we have on file from her docs.

She sees a headache specialist (6 hours away from home) who we see every 6 weeks or so. He has hospitalized her three times in the past 6 months for her headaches (as long as 12 days at a time). She sees either her primary doctor or her headache specialist at least every 2-3 weeks (most often sooner than that). She does physical therapy, chiropractic, massage, and acupuncture at least twice a week.

When I called to talk to her determination specialist, I was told that she could not be approved because of her headaches unless he could show that she has weekly office visits because of her headaches. Is this to be expected?

It irritates me because this is not at all the standard of treatment for headaches. It would do her no good to see the doctor more often than she does, nor could we afford it.

Thankfully we put in a lot of information about her severe depression and anxiety (mainly due to the chronic pain). She sees a licensed psychologist for this weekly and has seen / been evaluated by psychiatrists for this in the past, so hopefully we can get it by focusing on this more if we can't get it for the headaches. If they can't approve if for headaches because of the need for weekly visits, can they at least consider them as a contributing factor?

On a lighter note, I really like your blogs and found them to be very useful when putting together our disability application.

By the way, I would highly recommend seeing an "upper cervical specific" chiropractor for that crunch in your neck and back pain. It's the one thing that we have been doing lately that seems to actually help a little.

8:05 PM  
Blogger Disability Blogger said...

Hi Travis,

I'm not sure what to make of what the "determination specialist" told you. I assume this individual was a disability examiner. If that's the case, the examiner may have a little trouble with basic verbal communication. There's nothing in the social security impairment listing manual--or in any of the guidelines under which examiners operate--to indicate that an approval should be made based on X number of weekly office visits. There are some medical impairments for which "frequency" is an issue. Asthma and seizure disorder are examples of condition for which the frequency of attacks or episodes can be correlated to the severity of a disabling condition. However, even this is not the same as whether or not one has gone to see a doctor on a weekly basis. In this case, I would have to wonder if you actually spoke to a disability examiner or actually a field office claims representative who was speaking out of turn (claims reps take disability applications but most know practically nothing about how claims are adjudicated). If you spoke to a disability examiner, I find their response a bit puzzling since that's not how social security disability and SSI disability claim decisions are made.

4:05 PM  
Blogger Travis said...

Thanks for the information. This is exactly what I was thinking from what I have read about the process. The individual that I spoke with was listed as "adjudicator" on her work history and activities of daily living paperwork that they sent to us and the forms requesting information from her doctors, so I'm assuming that he is a disability examiner. He said that he was making a spreadsheet to keep track of all of her office visits for treating her headaches. He said that it had to be weekly treatment by a doctor of some type, but that if a chiropractor was giving her a treatment on her neck in hopes that it would help her headache, it wouldn't count because it wasn't really treating her headaches. This type of logic makes absolutely no sense to me...

8:21 PM  
Blogger Disability Blogger said...

Travis, I've actually used a local chiropractor before and the chiropractic physician gave me relief that no orthopedist could. SSA does not assign any weight to the records of chiropractors though. Only records from M.D.s on physical impairment cases.

4:14 AM  

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