Not necessarily recommending this person because I have no personal experience here, but there is some good info at the website.
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APPLYING FOR BENEFITS WITH LYME DISEASE
This information may help lyme disease claimants with representation, as well as claimants who are not represented by an attorney or non attorney representative. Understanding how the Social Security Disability system works can make the difference between winning or not winning the continuing disability benefits and backpay to which a person is entitled. To win a claim for disability benefits, claimants should learn about the disability process to improve their chances of winning. More information may be found at the social security disability blog.
Lyme disease is a disorder that can involve a number of different body systems (musculoskeletal, neurological, and cardiovascular). And due to the particular nature of lyme disease (exacerbations and remissions), individuals who have lyme disease can face an uphill challenge when they attempt to pursue either social security disability or ssi disability benefits.
Currently, Lyme disease is not listed in the social security administration's impairment listing manual.
Impairments that are listed in this manual, or the blue book as it sometimes called, may potentially qualify an applicant for social security disability benefits. This is, of course, provided that the severity of an individual's condition meets the criteria specified in the manual (which will be indicated in a person's medical records).
However, even though SSA has not included lyme disease as a "listed impairment", sufferers of lyme's may apply for, and potentially win, their ssd (social security disability) or ssi (supplemental security income) disability benefits.
And this is simply for one basic reason, as it relates to the disability claim process: the social security administration does not decide disability claims on the basis of a diagnosis, but, rather, on the restrictions and functional limitations that a person has a result of their medical condition.
Because of this fact, even though lyme disease is not a recognized disorder in the social security administration's impairment listing manual, it becomes especially important for lyme disease sufferers who are applying for disability benefits to do the following, which is simply to : make sure their various treatment sources (doctors, counselors, even physician's assistants) understand how important it is that the medical records and treatment notes that are generated for them include not only a diagnosis, prognosis, and objective observations (vitals, muscle strength, reflexes), but also include "descriptive" indications of the functional limitations they are experiencing as a result of lyme disease.
In other words, if a lyme disease patient is suffering neurological deficits that result in a loss of coordination and balance, this should be noted. If a patient is experiencing a decrease in grip strength in addition to an overall loss of muscle strength, this should be noted. And, certainly, if a lyme disease patient is experiencing mental deficits that lead to memory lapses and disorientation, this should be noted also (even when a disability claimant does not specifically allege a mental impairment, the limitations that result from such an impairment can be considered on a claim---as long as a patient's treatment sources have recorded this information for SSA to evaluate).
Why is this issue (having well documented records) so important? Simply because too many doctors keep progress notes that are "nondescriptive", or, sometimes, even useless. In fact, it is not at all uncommon for a disability claimant, or that claimant's lawyer or non-attorney representative, to request a doctor's medical records and find that the doctor has recorded very little information from each office visit---and hardly any information that was useful from the standpoint of successfully winning an SSD or SSI disability benefit case.
Disability Advocates Help with Claims Free Case Evaluation
Continue to part 2 - Social Security Disability, medical records, and functional limitations
AND FUNCTIONAL LIMITATIONS NOTATED IN MEDICAL RECORDS
This information may help claimants with representation, as well as claimants who are not represented by an attorney or non attorney representative. Understanding how the Social Security Disability system works can make the difference between winning or not winning the continuing disability benefits and backpay to which a person is entitled. To win a claim for ongoing and past due benefits, claimants should learn about the disability process to improve their chances of winning ssi or ssd - ssdi benefits.
How can physicians effectively note functional limitations in their treatment notes?
Simply by providing the same information that a social security disability claims examiner or an administrative law judge would search for while reviewing a claimant's medical records.
Disability claims adjudicators (DDS examiners and administrative law judges) tend to look for information that substantiates the following:
1. How much a claimant can lift - social security disability and ssi disability claimants are given an exertional rating. This rating which is performed on a form known as an RFC, or residual functional capacity form, takes into account a number of factors, not least of which is how much weight a claimant can lift on a frequent and occasional basis. For example, the ability to lift ten pounds frequently and twenty-five pounds occasionally equates to a Light RFC, while the ability to lift twenty-five pounds frequently and fifty pounds occasionally equates to a medium RFC.
2. How long a claimant can sit or stand - this is taken into consideration because a claimant's residual functional capacity in this area (i.e. the ability to sit or stand for certain lengths of time) will have a bearing on the types of jobs they will be considered capable--or incapable--of doing. For example, a claimant with severe knee problems might be considered incapable of doing work that involves prolonged standing. Likewise, a claimant with severe pelvic pain might be considered incapable of doing work that involves prolonged sitting, such as a sedentary job.
Though, these are hardly the only factors that go into determining a disability claimant's capacity rating. Other factors include how well a claimant can crouch, stoop, grasp objects, reach forward and overhead, hear, see...the list goes on.
Additionally, there are non-physical factors that may be considered as well. Claimants with pyschological and/or psychiatric impairments or who are suspected of having a mental impairment (a single mention of "depression" in a doctor's notes can signal this) are given a mental residual functional capacity, or MRFC, rating as well.
The major point to keep in mind is this: the claimant's residual functional capacity rating (physical, mental, or both) will always be based on the information contained in a claimant's medical records.
Therefore, if a doctor has provided little information in their records as to what a claimant is capable, or not capable, of doing, the DDS medical consultant will "conjure" his or her own conclusion in this regard. And this, of course, being a part of the disability determination process, will lead to the following:
1. A determination of whether or not the claimant should be able to return to their past work.
2. A determination of whether or not the claimant should be able to perform some type of "other work".
3. A determination as to whether or not the claimant should be approved or denied for social security disability or ssi disability benefits.
Of course, it goes without saying that even when a claimant's medical treatment sources have supplied strong supporting information (such as detailed records, or perhaps even a detailed letter or an RFC form completed by the claimant's own doctor), a DDS unit physician may still come to an entirely different conclusion (in other words, they sometimes ignore what a claimant's doctor has to say, despite the fact that they themselves have never seen nor treated the claimant).
However, despite this, in most cases an ssd or ssi claim will be strengthened if the records supplied by a claimant's doctors are very clear and unambigous regarding the claimant's functional capacities.
So, in other words, if a claimant is unable to lift more than five pounds or sit for longer than 15 minutes, ideally, the medical records should state this. If a claimant has memory problems and cannot retain new information for long periods, the records should, ideally as well, indicate this.
This, of course, begs the question: What can a person who applies for disability benefits do to ensure that their medical records contain the necessary details?
Ultimately, this is entirely in the hands of one's doctor. However, a disability claimant can attempt to gauge the helpfulness of their doctor's records by doing the following:
1. By speaking with their doctor, disclosing that an application for disability benefits has been filed, and impressing upon the doctor the value of functional limitations being reflected in the medical records. This, of course, may be easier said than done---but it does allude to the value and usefulness of maintaining a good relationship with one's treatment sources.
2. By obtaining a copy of one's medical records to determine the type of information that has already been recorded by one's doctors.
Of course, the most effective way for a treatment source to indicate a disability claimant's functional limitations (i.e. residual functional capacties) is via the submission of a letter or a completed RFC form.
Additional information regarding such letters and RFC forms can be found on the following pages:
A letter to support a social security disability case
Make sure your docs really do support your disability claim
What if your doctor won't support your ssd or ssi case?
What is an RFC, or residual functional capacity, form?
Winning Social Security Disability or SSI benefits
[ 11-17-2010, 02:28 PM: Message edited by: lou ]
Posts: 8430 | From Not available | Registered: Oct 2000
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posted
Wow, I am right on the same wavelength as you. I was just looking at that last night. I just want to add;
It is my understanding that they also ask for three(?) references. It is important that these references are also familiar with your limitations.
As we have all heard, "you look fine" or "you don't let lyme disease get in your way", when we modify our lives to accomodate it -IT IS IMPERITIVE THAT ANYONE WE TELL SS TO CONTACT IS FAMILIAR WITH OUR LIMITATIONS.
A claim may be denied based on vague responses to their questions.
Posts: 797 | From New York | Registered: Feb 2008
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ConnieMc
Frequent Contributor (1K+ posts)
Member # 191
posted
They ask for 1 3rd party contact at each level of appeal. The person you list on appeal paperwork does not have to be different, so you can use the same person throughout the process.
About half the time, during the initial or reconsideration periods, SSA sends a questionnaire to the person you list. The questionnaire covers ADLs and general function.
It is very important that this person know you pretty well since they are commenting on your daily activities. Ideally, a person who lives in the same household is preferable
Posts: 2275 | From NC | Registered: Oct 2000
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momindeep
Frequent Contributor (1K+ posts)
Member # 7618
posted
One of the acceptable criteria for receiving SSI is debilitating depression or mental health problems.
If you have a history of depression where you cannot function that is satisfactory for receiving SSI.
Posts: 1512 | From Glenwood City WI | Registered: Jul 2005
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posted
Sounds like Connie could help in the process. Guessing she gets paid for her services.
Posts: 8430 | From Not available | Registered: Oct 2000
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- As lyme also causes many vestibular problems (related to inner/ middle ear and balance), it is important to include any vestibular testing that has been done.
Topic: TINNITUS: Ringing Between The Ears; Vestibular, Balance, Hearing with compiled links - including HYPERACUSIS -
Posts: 48021 | From Tree House | Registered: Jul 2007
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
I am in the process of trying to decide to go after my disability for the third time. I had all the standard physical & mental tests done for a week at a medical school where they regularly test. I was off the charts disabled and that was in the early nineties.
So then I got a doctor from SS to check me over. He spent less than 5 minutes and declared me 100% disabled. But our applications were turned down on the basis that I had not worked within the last five years before the "diagnosis" whatever it was.
Last year I was finally diagnosed definitively with lyme disease et al. My LLMD wants me to fight for disability. If you read the doctor's letter from the 90's you would be amazed that I am even able to write to you!
Now that I am getting my faculties back thanks to my wonderful LLMD I realize how much those bums owe me!
I owned a business, had employees, was developing business parks, working 14 hr days and running a family and it all suddenly disappeared.
It was replaced with staggering medical bills, loss of my necessary income, disastrous and lasting effects on my daughter.
My husband's work stopped, his many patents of no use because he was my nurse. You don't even want to know what numbers my husband comes up with to measure our loss.
He was one of the originators of wireless technology and continues to consult on that and many other hi tech areas....when he can. He had to stay home to care for me all these years. And now we think he is getting sick....it just seems neverending! I can't blame him for being totally burned out.
Now I think I want to consult an attorney. We could research this over and over, reapply to no avail. I do believe I have the records to prove I had lyme in the late 80's when "a rash of unkown origin" appeared in my GP's handwritten notes.
Last week I wrote the first business plan I have written in over 22 years....thank you Dr. S and Bicillin!
We now live almost entirely on social security. We should be enjoying our retirement but my illness tapped us out completely. My son and daughter in law and three kids are moving in with us next month because they lost their house and need to gather enough cash to buy another one.
My husband points out that "families stick together no matter what".
Maybe I should be a test case and sue the CDC! I know a lawyer who did lawsuits like that (and won) but I think by now he is retired.
I will probably concentrate my energies on my grandchildren and on a few business ideas I am testing. Sometimes you just have to make hard choices. I will wait to see how it goes, to see where I need to spend my fragile energy for the highest good.
Good luck to all who apply!!!
-------------------- DOCTOR: "I don't think you are sick." PATIENT: "We are all entitled to our opinions. I don't think you are a doctor." Posts: 697 | From Northern California | Registered: Jul 2009
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