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Before you make your application to the Social Security Disability (SSD) Administration, there are several very important issues you first need to understand. I will share my own experiences with you, and then go on to explain what all you will need, the process itself, and what to expect.
I think probably the most common mis-conception about SSD is that your disability claim will be determined by your medical records and what your own physician has stated in your medical records. This is NOT how it works! You need to know that right up front. The SSD Administration has their own staff which makes the determination on each claim, and these people are not physicians! They are administrative employees whose job is to determine that you are not disabled by their definitions. It is therefore imperative that you educate yourself on the inner workings of this system prior to making your application. That is exactly what you will find here. I have already been through the process and have finally been awarded Disability Insurance Benefits, but I had to learn the hard way. I hope to make it easier for you.
I believe it is important to understand that a great many individuals who are not actually disabled make applications for SSD everyday. The SSD Administrations must therefore attempt to "weed-out" all these erroneous claims. To the best of my knowledge, the only claims for disability benefits which are automatically approved are those with either incurable cancer or AIDS, where death is the inevitable result. All others must prove their claims of disability. So, how do you go about proving your claim? That is what will be covered extensively here.
1.00: MUSCULOSKELETAL SYSTEM
2.00: SPECIAL SENSES AND SPEECH
3.00: RESPITORY SYSTEM
4.00: CARDIOVASCULAR SYSTEM
5.00: DIGESTIVE SYSTEM
6.00: GENITO-URINARY SYSTEM
7.00: HEMIC AND LYMPHATIC SYSTEM
8.00: SKIN
9.00: ENDOCRINE SYSTEM
10.00: [RESERVED]
11.00: NEUROLOGICAL
[SKIPPED 12.00 AND 13.00... N/A]
14.00: IMMUNE SYSTEM
* Arthritis and disorders of the Spine
* Vision, Hearing, Speech
* Asthma, Bronchitis, Pleuritis, etc.
* Heart disease, heart attacks, anurisms, etc.
* Gastritis, ulcers of stomach or colon, liver disease, persistent weight loss, etc.
* Imapirment of renal function, due to any chronic renal disease
* Nephrotic syndrome
* Chronic anemia, thrombocytopenia, spontaneous hemorrage, leukemia, cancers, etc.
(This includes all blood disorders, which Lupus patients definitley have)
* Any chronic skin condition, disease
* Diseases of the thyroid, pancreas, diabetes, etc.
* Epilespy and/or any type of seizures, Multiple Sclerosis, Vasculitis, Central Nervous System disorders, cognitive dysfunctions, periphereal neuropathies, etc.
(This would include problems with the brain and/or cognitive activity, Organic Brain Syndrome, Central Nervous System, Peripheral Nervous System, Sensory, Motor, and Autonomic Nervous Systems.)
* Systemic Lupus, Systemic Vasculitis, and all other connective tissue disorders
[B.]
14.02 CATEGORY OF IMPAIRMENTS FOR SLE:
Documented as described in 14.00 [B1], with:
- OR -
A longitudinal clinical record of at least 3 months demonstrating active disease despite prescribed treatment during this period with the expectation that the disease will remain active for 12 months is necessary for assessment of severity and duration of impairment.
In addition to the limitations caused by the disease, the chronic adverse effects of treatment (drug and/or other) may result in functional loss.
A severe loss of function in a single organ or body system, or lesser degrees of functional loss in two or more organs/body systems.
Case examiners of the Social Security Administration (SSA) look for clearly explained diagnosises, clinical findings and test reports, and for specific explanations of the patient's inability to perform productive tasks and sustained work activities.
IMPORTANT NOTE: Sustained work includes the ability to complete and continue tasks in a timely manner throughout the day, over a long period of time, and/or the capacity for regular attendance. To the extent one's productivity suffers by more than 12 to 15 percent, one would not have the capacity to function in a competive work setting. Such a loss of productivity is deemed significant by the SSA and the physician should explain this in his report.
The above paragraph is extremely significant for lupus patients applying for Disability Benefits. The explanation of sustained work, made by the SSA, clearly states that the inability to be an efficient employee throughout a work day, and to be a dependable employee in regular attendance is, by their own definition, considered a disability. This should be emphasized in your application and you may even want to quote it somewhere in your correspondance. When I wrote my letter requesting a reconsideration after my first denial, I used this quote in my letter as my reason for requesting a reconsideration.
Here is a list which you can use as a guideline for your doctor visits and for your SS claim. In addition to this list, you also need to keep a daily record of your symptoms and over-all condition. It doesn't have to be detailed every day; simply note how you slept the previous night, how you felt upon waking, and how you felt throughout the day. If a new symptom occurs or an old one recurrs, be sure to note this. If you experience particular difficulty with certain tasks, make a note of them. Your SS application will ask for more details than you can imagine! So begin with these guidelines before making your application, and give a copy to your physician so that it will be in your medical file.
IMPORTANT NOTE: Keeping such a journal is also crucial after you are approved for Social Security Disability Benefits. Once approved is not forever approved! About every 3 years, the SSD Administration will review your case and all medical records to determine if there has been substancial improvement in your condition that would enable you to return to work. Therefore, you need to continue keeping a daily, or at least weekly journal of your symptoms, doctor visits, medications, side-effects, impairments to daily living, etc. When your case is called for review, you will be expected to present this information, even though you will not be told this when you are initially approved!