Disability Denial Attorneys Blog

Long-Term Disability - Social Security Disability - Veterans' Disability

Does Spinal Cord or Nerve Root Lesions Qualify for Social Security Disability Benefits? Yes! Try Using SSA Listing 11.08.

Published on September 11, 2015 by

When your nerve roots or spinal cord become damaged due to disease, you can lose some – or all – of your ability to move. In some cases, you may just feel numbness in certain areas of your body. More severe cases, though, can cause people to experience paralysis in their arms, legs, or even from the neck down.

Obviously, people who can’t move tend to have trouble finding work, so the Social Security Administration has chosen to recognize this as a potentially disabling condition. All you need to do to get Social Security disability benefits is qualify.

That means either matching a listing in the Listings of Impairments or proving that your issue is the equivalent of a condition included in the Listings.

The Listing of Impairments is essentially the SSA’s disability encyclopedia. In this extensive guide, you’ll find each and every disabling condition that the SSA recognizes clearly defined, along with criteria that you have to match if you hope to qualify for Social Security disability benefits. If you can match the requirements in the listing, you will be eligible for benefits.

Sadly, the second qualification method is not quite so straight forward. To prove equivalency, you need to find a way to convince the SSA that your impairment is just as bad as a condition that they have already included in the Listings. This is a much more complicated task, one that will require a skilled disability lawyer who understands how the SSA works and has successfully handled this type of case in the past.

Before you choose that route, you should always first see if you can match the listing.

11.08 Benefit Criteria

The only criteria offered by the SSA for this condition says that you

  1. Have to have nerve root or spinal cord lesions, and
  2. Have motor functions that are “disorganized” as defined in 11.04B

To help you prove your case, the SSA recommends using any of the following medical tests:

  • Anorectal monometry
  • Cerebrospinal fluid
  • Deep tendon reflexes
  • Dejerine’s sign
  • Magnetic resonance imaging of spinal cord and spine
  • Magnetic resonance neuropathy
  • Motor evoke potentials
  • Myelography
  • Somatosensory evoked potentials
  • Straight leg raising test

If you get positive results on any of these tests, it will go a long way towards helping you prove your case and win your claim.

When Equivalency Is the Only Option You Have

Remember that it’s not the end just because you can’t match a listing. Equivalency is still very much an option, and even though your path will be more difficult, that doesn’t mean that you don’t have hope.

In fact, skilled disability lawyers have helped many people just like you to use equivalency to get the benefits that they need. Your job, if you have to go this route, will be to use the Five Step Sequential Evaluation Process to produce evidence that shows you have been unable to work for at least 12 months due to your medical condition. If you and your attorney are able to do this effectively, you will qualify for the benefits that you need.

Learn even more about the claims process by reading our Social Security Disability eBook for free and be sure to check back weekly for more information on how you can get the Social Security disability benefits that you deserve.

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Veterans Disability: Marine Corps Base Camp Lejeune Drinking Water Chemical Exposure Reviewed by VA

Published on September 11, 2015 by

In order to keep to their ongoing commitment to provide continuing care to all Veterans and their families, the Department of Veteran Affairs announced this month that they will begin the process of revising regulations to establish service connections for conditions resulting from exposure to contaminated water at the U.S. Marine Corp Base Camp Lejeune in North Carolina.

The new review may add an additional condition to the 15 conditions the VA already provides healthcare for to those eligible Veterans who were stationed at Camp Lejeune for 30 days or more between August 1, 1953 and December 31, 1987. The regulation revision stems from the Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012. The VA currently also provides reimbursement of healthcare expenses for the 15 conditions currently listed to all eligible family members who resided at Camp Lejeune during the same time frame.

In a meeting between the Secretary of Veterans Affairs, the Director of the Agency for Toxic Substances and Disease Registry (ATSDR) and Senators Isakson, Burr, and Tillis, the creation of presumptions for potential service connection for disease associates with the contaminated water at Camp Lejeune were discussed in great detail.

The disease currently being reviewed for possible presumptions for service connection are:

  • Kidney Cancer
  • Angiosarcoma of the Liver
  • Acute Myelogenous leukemia

These diseases are known to be related to long term exposure to contamination of the drinking water at Camp Lejeune between the 1950’s and the 1980’s. They stem from the chemicals, Benzene, Vinyl Chloride, Trichloroethylene and Perchloroethylene, which are all volatile organic compounds used in components of fuels and many industrial solvents.

In addition to working with ATSDR, the VA may potentially enlist the National Academy of Sciences in order to utilize their wide breadth of knowledge regarding the exposure to these chemicals and the subsequent development of additional diseases.

Veterans who believe their health conditions may be related to exposure to the water at Camp Lejeune should file a claim for veterans disability compensation. The U.S Marine Corps also encourages all those who lived or worked at Camp Lejeune before 1987 to register for notifications regarding Camp Lejeune Historic Drinking Water here.

If you have questions regarding your possible Camp Lejeune veterans disability or any veterans disability, please contact our experienced attorneys, we are here to help.

Keep up with the latest in Veterans Disability news by following our blog, and be sure to download a copy of our free eBook , Veterans Disability Claims; Strategies for a Winning Campaign, to learn more about the veterans disability claims process.

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AETNA LTD Denial is reversed by Marc Whitehead & Associates for Client with Thoracic Lumbar Radiculopathy

Published on September 11, 2015 by

Our firm successfully represented a 48 year old woman, from Savannah, Georgia, in her recent appeal of an Aetna Life Insurance Company's denial for long-term disability (LTD) benefits. We were able to take the responsibility for the appeal off of her shoulders and win her the benefits that she deserves.

Our client suffers from thoracic lumbar radiculopathy, fractured ribs, sleep apnea, depression and anxiety. She also has severe ongoing pain which she has managed with nerve blocks, physical therapy, and heavy medication. She is unable to sit for prolonged periods of time. Her concentration is impaired. She also has difficulty coping at times with her pain symptoms and is depressed as a result. Certainly, she can’t perform the duties of any occupation with reasonable continuity.

The problem with the opinion of the AETNA disability claim analyst, who denied the claim, was that there was no explanation of why they doubted the accuracy of our client’s medical complaints and the opinions of her treating physicians. The crux of the disability insurance companies' opinion after reviewing the medical documentation regarding her pain, restrictions and limitations and her ongoing treatment, is that they felt she could work in a sedentary capacity. Aetna never addressed fully the effects of her pain and the side effects of her medication. Sedentary work in a competitive work setting does not allow for the taking of unscheduled work breaks due to frequent and severe pain. Likewise, all occupations require a certain level of productivity and this is just not something our client can do.

The records we provided as part of our client’s administrative appeal, specifically her treating physicians' opinions, helped to contradict Aetna's determination. Our client’s impairments prevent the performance of any work at all at the present time. We went on to prove that rather than rely on the opinions of treating physicians, the disability insurance company supported its own conclusions with an unreasonable interpretation of a Functional Capacity Evaluation and an unreasonable vocational assessment. Aetna was not justified in rejecting the opinions of treating physicians as well as our client’s statements.

In our appeal we were able to supply evidence which explain our client’s inability to perform the duties of any of the occupations that Aetna suggested. We were able to show that our client’s impairments, including multiple right sided rib fractures which are recurrent and produce unmanageable pain and are produced from minimal stress or movement, render her incapable of performing the duties even of sedentary work.               

Our appeal also went into great detail to how Aetna did not take into consideration how our client’s pain affected her ability to work. There was a great deal of well documented medical testing which indicated an objective reason for our client’s pain. Many courts have found that non‑exertional, or pain, limitations can trump what would otherwise be a capacity to engage in sedentary work. Ignoring pain limitations may be found to be an indication of uncertainty on the part of the insurance plan administrator.

Social Security has already agreed that our client is disabled from any occupation at any level and granted her disability benefits before her LTD insurance benefits were denied. However, Aetna persisted in denying our client’s LTD benefits by asserting that she can perform the duties of a sedentary occupation.

We were able to show that although the disability insurance company claimed it did not have the same medical information as the Social Security Administration, Aetna provided representation for our client through a 3rd party company, Allsup, and constantly monitored our client’s progress and SSA disability benefits award. We thus proved that Aetna could have easily obtained her SSA file.

By researching every medical document, requesting additional testing and physician statements, and carefully reviewing of each statement made by the disability insurance company, we were able to create a solid argument against their denial of our client’s LTD claim. We were also fortunate enough to have a supportive Aetna senior appeal specialist who thoroughly examined each document we sent and came back with a decision to overturn the previous Aetna disability claim analysts’ denial and thus approve LTD benefits for our client.

If you believe that your long term disability insurance benefits have been wrongfully denied or terminated, please contact our firm for a free consultation. Be sure to follow our blog for the latest long term disability insurance news and updates and download a free copy of our soon to be in print e-book, Disability Insurance Policies: How to Unravel the Mystery and Prove Your Claim for even more information!

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How to Win Long Term Disability Insurance Benefits for Unspecified Somatic Symptoms

Published on April 10, 2015 by

Recently we went into detail about a disorder in the DSM-5 called Other Specified Somatic Symptom & Related Disorder. The idea behind this disorder is that sometimes people suffer from specific somatic issues that just don’t fit into the exact definition of any of the known somatic disorders. Doctors know that you are suffering from a somatic issue because there are specific somatic symptoms, but they can’t put you into a premade box.

What’s the difference between that and Unspecified Somatic Symptom & Related Disorder? Whereas in the previous condition the symptoms themselves were quite specific but just didn’t meet the definition of a particular somatic disorder, people suffering from this disorder aren’t even suffering from specific somatic symptoms.

However, they still have to deal with issues causing them “clinically significant distress” or functional impairment in occupational, social, or other matters that lower their quality of life and make it difficult to live normally.

How Can Someone Be Diagnosed with Something “Unspecified”?

That’s the big question here, and the answer is: they aren’t. Or at least it doesn’t happen a whole lot. The fact that this category exists tells you that the experts thought it was important enough to include, but even in the definition, there is a note saying that it shouldn’t be used except in special circumstances.

What kind of special circumstances? Generally speaking, people are not diagnosed with this disorder unless there’s just too little information for a physician to come up with a diagnosis that is more specific. Basically, this is a medically acceptable way of saying, “something’s wrong, but I don’t know enough to tell me what.”

How do you combat this if you are filing for disability? Provide as much medical information and evidence as you can. The more doctors have to go on, the easier it is for them to come up with a specific diagnosis – which makes it harder for your insurer to fight. It’s not always easy and this is why having an experienced long term disability insurance attorney on your side makes all the difference.

Download our free disability eBook to learn more about how long term disability insurance works, and then call our offices to talk to one of our qualified professionals about your specific situation.


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