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How to Win Social Security Disability Benefits for Pneumoconiosis by Using SSA Listing 3.06.

Published on May 27, 2015 by

Do you work in conditions that require you to regularly inhale asbestos, coal, silicon, or beryllium? Is it often difficult for you to breathe? Sometimes, when you breathe in certain dust-like particles, they can stay in your lungs and lead to inflammation and more mucus that obstructs your airflow.

When you can’t breathe, it makes everything you do that much harder. Physical exertion can become next to impossible, and many people find that they’re just not able to work. Because of this, the Social Security Administration includes pneumoconiosis in their Listings of Impairments. In other words, if you have it, it is possible that you can qualify for social security disability benefits.

How do you apply? There are two methods.

The first is to attempt to prove that your condition matches the definition and meets the requirements of something listed in the Listings of Impairments. This compendium of qualifying disorders lists every debilitating medical issue that the SSA recognizes and tells you exactly what criteria you need to meet for each issue in order to get social security disability benefits.

If you cannot show that your issue matches their specific criteria, you have another option, utilizing the Five Step Sequential Evaluation Process to prove that what you’re going through is just as serious. In short, that your condition is equivalent in severity to something the SSA already recognizes and therefore deserves benefits.

It is always best to start with option one, because it’s simpler to prove that you meet criteria that has already been set down than it is to attempt to argue equivalency.

Getting Disability Benefits for Pneumoconiosis

Because pneumoconiosis just refers to the dust particles settling into your lungs, and because there are numerous symptoms and conditions associated with this problem, the criteria for qualifying with this issue are the same as with Listing 3.02 Chronic Pulmonary Insufficiency. You must meet one of the following three qualifications:

  1. You have chronic obstructive pulmonary disease, and your forced expiratory volume (FEV) is equal or less than the values here:

 

TABLE I
HEIGHT W/O SHOES (INCHES) FEV (EQUAL TO OR LESS THAN)
60 or less 1.05
61-63 1.15
64-65 1.25
66-67 1.35
68-69 1.45
70-71 1.55
72 or more 1.65

 

  1. You have chronic restrictive ventilator disease, and your forced vital capacity (FVC) is equal to or less than the values here:

 

TABLE II
HEIGHT W/O SHOES (INCHES) FCV (EQUAL TO OR LESS THAN)
60 or less 1.05
61-63 1.35
64-65 1.45
66-67 1.55
68-69 1.65
70-71 1.75
72 or more 1.85

 

  1. Your clinically documented pulmonary disease has caused chronic gas exchange impairment with:
    1. Single breath DLCO (diffusing capacity of the lungs for carbon monoxide) that is less than 40 percent of the predicted normal value or less than 10. ml/min/mmHg; or
    2. Simultaneously determined arterial blood gas values of PCO2 and PO2 that are measured on two or more occasions, at least three weeks apart over a 6-month period, while you are at rest in a clinically stable condition and are equal to or less than the following values:

 

TABLE III-A(for test sites less than 3,000 feet above sea level)
Arterial PCO2 (mm Hg) Arterial PO2 Equal to or Less than (mm Hg)
30 or below 65
31 64
32 63
33 62
34 61
35 60
36 59
37 58
38 57
39 56
40 or above 55

 

TABLE III-B(for test sites 3,000-6,000 feet above sea level)
Arterial PCO2 (mm Hg) Arterial PO2 Equal to or Less than (mm Hg)
30 or below 60
31 59
32 58
33 57
34 56
35 55
36 54
37 53
38 52
39 51
40 or above 50

 

TABLE III-C(for test sites over 6,000 feet above sea level)
Arterial PCO(mm Hg) Arterial PO2 equal to or less than (mm Hg)
30 or below 55
31 54
32 53
33 52
34 51
35 50
36 49
37 48
38 47
39 46
40 or above 45

 

  1. Simultaneously determined arterial blood gas values of PCO2 and PO2 during “steady state exercise breathing room air” that is equal to or less than the specified values in Tables III-A-C, when the level of exercise is equal to or less than 5 METs or 17.5 ml O2 consumption/kg/min.

Obviously, these are very specific criteria, and you will likely need the help of an advocate with a lot of experience in order to understand them. But it can also be helpful to know which tests you can take to help your case. There are a number that the SSA deems acceptable:

  • Arterial Blood Gas Study (Resting)
  • Arterial Blood Gas Study (Exercising)
  • Chest X-Ray
  • Bronchial Challenge Test
  • Carbon Monoxide Diffusing Capacity
  • Sputum Collection
  • Functional Residual Capacity
  • Bronchoscopy
  • Lung Subdivisions
  • Spirometry
  • Computerized Tomographic Scanning of the Chest
  • Thoracic Gas Volume
  • Pulse Oximetry
  • Biopsy

With a positive result on any of these, your claim stands a much better chance at succeeding.

There’s Always Equivalency

Don’t forget, you can still use the Five Step Sequential Evaluation Process to prove equivalency if you are unable to meet the specific criteria outlined in the Listings of Impairments.

With the help of an experienced disability attorney, you can work to show the SSA that your condition has prevented you from working for at least 12 months. It’s not as simple or straightforward as it sounds, but it can be done – you just need someone in your corner who knows how the system works and what facts and arguments to use to support your claim.

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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Long Term Disability Insurance Benefits: What Happens When Psychiatrists Don’t Do Exams?

Published on May 22, 2015 by

Chances are pretty good that your regular physician wouldn’t diagnose you with a specific ailment without seeing you first, right? Why, then, is it considered okay for psychiatrists to offer their professional opinion on a person – an opinion that may go a long way towards deciding whether or not that individual gets the long term disability insurance benefits they need – without conducting a personal examination?

The answer is that it isn’t considered okay – usually.

Ethic Guidelines for Forensic Psychiatrists

The American Academy of Psychiatry and the Law demands that practicing psychiatrists always strive for objectivity, honesty, and adequacy when offering their medical opinion about a client, and do their best not to have their opinion distorted by their relationship with the party that retains them. In short, that means psychiatrists shouldn’t be influenced by the person or company that’s paying them.

But if you continue reading, these ethic guidelines say that it’s only okay for psychiatrists not to personally examine a patient in specific circumstances, such as when doing record reviews related to malpractice cases. Otherwise, they need to make “appropriate effort” to engage in a personal examination of the person in question.

What happens if the psychiatrist isn’t able to examine the patient despite their best efforts? Well, they are allowed to offer an opinion, but it’s one that will be loaded with caveats. They are required to state clearly that no personal examination occurred and explain how this limits their opinions and any conclusions that can be drawn from them. Additionally, the guidelines explicitly say that opinions provided without examination can be called into question.

How Opinions Get Their Weight

Because of the problems inherent with opinions offered without examination, it is vital that your representative be aware if you weren’t personally examined. To that end, you always want to make sure that your personal doctor conducts a personal examination so that his or her opinion will be given the weight that it is due. And on the flip side, if the insurance company attempts to lend similar weight to a contrary opinion that isn’t accompanied by an exam, you need to fight back against this tactic.

In order to win your claim and get the long term disability insurance benefits you need, it is key to understand how disability insurance policies work within the framework of disability laws. That’s why we offer a free eBook on the subject and are happy to sit down with you for a no-cost consultation to discuss the specifics of your case.

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How to Win Social Security Disability Benefits for Cystic Fibrosis by Using SSA Listing 3.04

Published on May 20, 2015 by

Cystic fibrosis is a life-threatening disorder that causes normally thin and slippery fluids like sweat, mucus, and digestive juices to become thicker and stickier and build up in important areas of your body such as your digestive tract and – quite commonly – the lungs. Too much buildup and you won’t be able to breathe. It is a condition that necessitates daily care and makes it a lot harder to do things that most of us take for granted, such as going to school or work.

The vast majority of people diagnosed with cystic fibrosis today now live into their 20’s or 30’s, and some even live to their 40’s or 50’s, but it’s still serious enough that the SSA offers disability benefits for those who qualify.

So how do you go about qualifying? Use one of two methods:

Meet the criteria. In order to make the disability benefit application process go more smoothly, the SSA has put together a compendium of recognized conditions called the Listings of Impairments that both defines each disorder and lists specific qualifying criteria. Meet the criteria for a particular listing and you’ll automatically qualify for benefits.

Go through the Five Step Process. Not everyone can meet the specific criteria, but that doesn’t necessarily mean you can’t receive benefits. The SSA understands this, so they have created a secondary method by which you can qualify – prove that your medical condition is equivalent to a different issue they have already recognized.

First, let’s look at meeting the criteria in the listing for cystic fibrosis.

Disability Benefit Criteria for Cystic Fibrosis

Simply having cystic fibrosis isn’t enough to earn you benefits. You also have to meet one of the following three requirements:

  • Have a persistent pulmonary infection that is accompanied by episodes of increased bacterial infection, happens at least once every six months, and necessitates nebulization antimicrobial therapy or intravenous therapy.
  • Experience recurring pneumonia, bronchitis, hemoptysis, or respiratory failure that
    • Require the intervention of a doctor
    • Happen at least six times a year (inpatient hospitalization over 24 hours counts as two episodes)
    • Are evaluated for at least 12 months to determine frequency
  • Have an FEV that is equal to or less than the values below:
Table IV
Height w/o Shoes FEV (equal to or less than)
60 or less 1.45
61-62 1.55
63-64 1.65
65-66 1.75
67-68 1.85
69-70 1.95
71 or more 2.05

 

Accepted SSA tests that can benefit your case include:

Arterial Blood Gas Study (Resting)

Chest X-Ray

Polymerase Chain Reaction

Sputum Collection

Bronchoscopy

Spirometry

Computerized Tomographic Scanning of the Chest

Pulse Oximetry

Sweat Chloride Test

A positive result on any of these tests can serve as great support to your claim.

Requirements in the Listings of Impairments Too Much for You?

As mentioned above, not everyone who ultimately receives benefits is able to meet the criteria for their specific disability in the Listings of Impairments. They need to prove their issue is equivalent to a listed impairment by using the Five Step Sequential Evaluation Process.

Because doing it this way isn’t as straightforward as simply matching a listing, you’re going to want to work with a disability attorney that you trust. Ultimately, your goal will be to prove that your medical condition has prevented you from being able to work for 12 months or more. Do this, and you’ll receive 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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How Can You Win Your Long Term Disability Insurance Benefits for Complex Regional Pain Syndrome?

Published on May 15, 2015 by

Do you suffer from intense pain that is not getting better, but worse? Did you get hurt only mildly, but continue to experience severe pain that goes beyond what you think you should be feeling? These are just a few of the ways that Complex Regional Pain Syndrome, or CRPS, can appear in an individual.

Sadly, because there are no objective tests or criteria that can prove a CRPS diagnosis, this is one of the five conditions listed as “subjective disorders,” and it is incredibly hard to win long term disability insurance claims for this issue. You both have to know the disability inside and out, as well as understand what insurance companies require in order to accept your claim and give you the long term disability benefits that you deserve.

Symptoms and Criteria for Complex Regional Pain Syndrome

CRPS is more than just pain that is unexplained. It can include a feeling of burning, increased difficulty in moving affected body parts, changes in growth patterns for hair and nails, stiffness, swelling, and skin oddities such as:

  • Skin that is thin and shiny
  • Excessive sweating
  • Temperature variations where one extremity is warmer than the other
  • Discoloration where the skin becomes red, purple, pale, or blotchy

Beyond this, what one person experiences with Complex Regional Pain Syndrome may bear little resemblance to what another person goes through. Symptoms vary widely in length and severity. For example, while one victim of CRPS may have their hair stop growing entirely, another can have a growth spurt. There are even cases of sufferers injuring one extremity and then having pain in the opposite extremity. And to top it all off, if you start to experience stress due to your condition, the symptoms can get worse.

With the absence of specific objective criteria, individuals applying for long term disability will need all the medical history on their side that they can produce. That means making sure that your doctor documents everything and understands how to speak the language of the insurance companies when offering his or her diagnosis. If mistakes are made, you can lose out on your chance to get the long term disability insurance benefits that you need.

To make sure you are armed with the knowledge you need, we recommended reading through our free eBook on disability insurance policies and setting up a free consultation with an experienced long term disability insurance attorney as early on in the process as possible.

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