Articles Posted in Boston SSDI

The wild misconceptions surrounding Social Security Disability Insurance benefits never cease to amaze our Boston disability benefits lawyers.

There are these misguided – yet common – notions that because there are more recipients, there must be fraud, or that because there are more applicants, it must somehow be quite easy to land this “free money.”

The truth could not be further from that. Our population is growing and aging – two factors that contribute significantly to the ballooning of disability rolls.

The fact is, people who are well-qualified often must wait months if not a year or more just to have their case reviewed. Even then, the vast majority of applicants are not approved. Those who continue on to the appeals process have somewhat better odds, but it is by no means a given.

In light of all of this, we can certainly see the need for reform. At a hearing before the House Ways and Means Social Security subcommittee, a retired administrative law judge testified that claimants should be made to come to hearings armed with more information regarding their disability.

As it stands, there is already an inordinate amount of information required for claimants at hearings.

The subcommittee has been hosting a series of hearings on the molasses-slow claim determination process. Managers for SSDI said they have attempted to streamline the process, particularly by setting special parameters for those who have severe and clear-cut disabilities (known as Compassionate Allowances). However, others moving through the process can take years.

At another of those subcommittee hearings, a policy specialist with the Center on Budget and Policy Priorities, indicated that Congress should boost financial support for the administrators of the SSDI program, as right now, the resources are scant for what they are expected to accomplish. As it now stands, congress treats the budget of the Social Security Administration as a form of discretionary spending. This is despite research showing that spending money at the front end can help to significantly reduce abuse and fraud and help to ensure that those who need the benefits most aren’t overlooked.

Another additional proposal is to amp up the requirements of those representing disability claimants. A decade ago, only about a tenth of claimants were represented by a third party, such as an SSDI attorney. Now, it’s about 80 percent.

With lax criteria for who can be a representative, it’s unfortunate that many claimants receive sub-par representation.

The original rules as they stand were written to accommodate claimants who were going forward on their own. But the administrative judge says more stringent requirements should be made of certain professionals, particularly attorneys, with regard to ensuring all the evidence is appropriately submitted and in a timely manner.

This is not a requirement that would concern us in the least, as these are the standards to which we already adhere.

You can ensure that your needs and interests will be held in the highest regard when you hire our experienced, caring SSDI lawyers to represent you.
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March is Traumatic Brain Injury Awareness Month, and it’s worth noting that Boston University School of Medicine researchers have been at the forefront of brain injury studies.

Our Boston Social Security Disability Insurance attorneys have handled cases for countless clients on the personal injury side of our practice. While it’s true that the brain is a miraculous organ with this amazing propensity for resilience, it’s also incredibly vulnerable to damage.

Often when we’re talking about a traumatic brain injury, there is the assumption of a war injury or a football players who take regular hits to the head.

But in fact, there are many different ways that people incur serious and permanent brain injuries. One of the most common of those is motor vehicle accidents, where many victims often experience sudden and powerful blows to the head. Construction workers too are at high risk of head injuries, as they tend to be at a much higher risk for falls at elevated levels. Even children may risk permanent brain damage from an injury sustained in a playground fall or during recreational sports.

The Centers for Disease Control and Prevention, which are working to raise awareness about TBIs this month, indicate the following:

• Males have the highest rate of traumatic brain injury;
• Young children and elderly adults are at the highest risk for a fall-related traumatic brain injury;
• Adolescents and young adults between the ages of 15 and 24 have the highest rate of motor vehicle crash-related brain injuries;
• Adults older than 75 are more likely to be hospitalized for a brain injury and are more likely to immediately die from it than any other age group.

Traumatic brain injuries are a specific listing of disability impairment noted as “cerebral trauma.” This heading goes onto list conditions such as epilepsy, central nervous system vascular accident or organic mental disorders – all of which are subsets of TBI.

Epilepsy is a seizure disorder that can stem from a brain injury. In order to qualify, you would have to experience a certain type and frequency.

Central nervous system vascular accident refers to a series of conditions you might have following a stroke or other brain injury. This would include difficulty with language and communication and/or persistent and significant disruption regarding the use of your arms, legs, fingers, hands or in walking.

An organic mental disorder would be something that has resulted in significant emotional or cognitive changes stemming from the brain damage you or your loved one suffered.

Even if you don’t meet any of these specific criteria, it’s very possible our SSDI lawyers can make a strong case for your entitlement to benefits on the basis of your inability to work. That is, we would argue that your residual functional capacity has been severely limited.

If you have suffered a traumatic brain injury, it’s highly likely you might not be able to return to your old job. But that’s not enough to prove disability. We have to take a step further by proving your disabilities are so severe that you are not likely to succeed in virtually any job for which you would otherwise be qualified.
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There has recently been some great news on the breast cancer research front, where the Massachussetts-based firm ImmunoGen Inc. was given the FDA green light for its cancer treatment using a drug called Herceptin.

Our Boston Social Security Disability Lawyers understand that this experimental drug, also known as T-DM1, is going to marketed as Kadcyla to patients with HER2-positive mestatic breast cancer who have already gotten prior treatment with a combination of chemotherapy and Herceptin.

It’s pricy, though – approximately $9,800 a month for now. Still, many hail the decision to approve the life-saving drug. The main complaint, according to the Boston Business Journal, was that it had taken seven years to approve in the first place – far too late for far too many breast cancer patients.

Breast cancer is the second most common type of cancer in the world, and sometimes, if untreated, may be deadly. Prognosis may be positive, however, for those who catch the progression fast enough.

But a diagnosis of breast cancer is not enough to secure SSDI benefits. To understand who is eligible, first let’s give a little background of the way we measure the severity of the disease. We rate breast cancer stages on a scale of Stage 0 to Stage 4. The higher the number, the more advanced the cancer is.

Stage 0 cancer involves non-invasive cancers. In this stage, cancers or abnormal pre-cancerous cells haven’t yet spread from the part of the breast where they first formed.

Stage 1 breast cancer involves cancerous cells – up to 2 centimeters – that have begun to invade nearby tissues, excluding lymph nodes.

Stage 2 cancer is divided into 2A or 2B. In 2A breast cancer, doctors are unable to find cancer cells in the breast, but they are able to find it in the lymph nodes located under the arms. In 2B, the tumor is at least five centimeters, but hasn’t spread to the lymph nodes under the arm or is less than 5 centimeters, but it has spread to the lymph nodes under the arm.

Stage 3 breast cancer is divided in 3A, 3B and 3C. Stage 3A breast cancer means there is no actual breast tumor and it’s all located in the underarm lymph nodes and has spread to the nearby breast bone and is sticking to other areas as well. Stage 3B breast cancer means that the tumor – any size – has spread to the breast skin, chest wall both and that it may be invading other axillary lymph nodes well. Stage 3C breast cancer means that the tumor has spread to the breast skin and chest wall and lymph nodes above and below the collar bone, as well as the lymph nodes under the arms and/or near the breast bone.

And then there is Stage 4 breast cancer. This is where the cancer has invaded other vital organs in the body, such as the brain, lungs, bones or liver.

Women who have been diagnosed with stage 4 breast cancer or cancer that is inoperable have been given an expedited means to disability benefits through a compassionate allowance.

In less serious cases, the administration is going to evaluate your breast cancer disability claim under Section 13.10, breast cancer. In order to meet the listing criteria, the administration requres that the cancer be locally advanced (or with inflammatory cancer, it can be a tumor of any size with extension directly to the skin or chest wall or internal mammary lymph nodes) or one with mestastases to the nearby bones or to 10 or more lymph nodes. Alternatively, if the breast cancer is recurrent, you would qualify for disability benefits.

The explanation is quite technical, but if you have questions about whether your condition likely qualifies you for disability benefits, we are happy to answer your questions.
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Along Interstate 93, you may have taken notice of a large billboard near the Zakim Bridge, where the American Liver Foundation displays the face of a 40-year-old Boston-area man who successfully fought for his life after finding himself near-death due to liver disease.

Our Boston Social Security Disability Lawyers hope that others suffering from chronic or acute liver conditions will find hope and encouragement in his story. These individuals should recognize too that while they embark on their own fight for life, they may well qualify to receive federal disability benefits to help them and their families stay afloat financially during treatment.

Section 5.05 of the Social Security Disability impairment listings address chronic liver disease in adults. The question of whether one qualifies according to the listing will be based on levels of hemorrhaging, requirements for blood transfusions, related infections and fluid imbalances that might alter behavioral or mental functions. Also, anyone who has reached the point with their liver disease where they may need an actual liver transplant will likely qualify for federal benefits.

Even those whose illnesses don’t meet the exact criteria may be able to make a strong case for why the conditions, treatments or medications prevent him or her from the ability to work, showing a significantly reduced residual functioning capacity.

The Centers for Disease Control estimated that in 2009, some 101,000 people were diagnosed with chronic liver disease or cirrhosis. It results in 10.3 deaths per population of 100,000, which amounts to about 32,000 deaths in this country annually.

In the case of the 40-year-old billboard survivor from Massachusetts, he was 24 when he was diagnosed with a form of liver disease known as primary sclerosing cholangitis, or PSC. It is characterized by bile ducts on the outside and inside of the liver narrowing due to inflammation and subsequent scarring. We don’t know what causes it, but we do know that those who suffer from inflammatory bowel diseases are about 70 percent more likely to get a PSC diagnosis as well.

For the next three years after that diagnosis, he was in and out of hospitals, suffering from severe pain and weakness. It seemed to be a never-ending cycle of infections, fatigue, medications and treatments. Eventually, the antibiotics he had been given weren’t strong enough to combat the disease, and he would end up hooked to IVs for weeks on end.

At the time, he was newly married with an infant daughter. Yet, he was unable to work. This is the exact kind of scenario for which SSDI benefits were intended.

He lost a significant amount of weight – from a hefty 240 pounds down to a skeletal 120 pounds. In an effort to improve his chances to receive a liver transplant, he underwent surgery to have his colon removed.

Eventually, his brother-in-law, a police officer, proved a match for a transplant. Both underwent surgery in the summer of 2001. It was a beautiful success, with neither suffering any complications in the dozen years since.

Our disability insurance lawyers have sincere hope that every story will have an ending this happy. In the meantime, let us worry about your disability claim.
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Inflammatory arthritis and other rheumatic conditions is the top reported reason for adult disability in the U.S. – and it has remained this way for the last 15 years, according to the Centers for Disease Control.

Our Boston Social Security Disability Insurance attorneys are familiar with the rigorous process through which the administration puts claimants in order to prove that their case qualifies. A diagnosis alone will not be enough to cut it, which is why it’s important for arthritis sufferers to be armed with the facts and then meet with an attorney before filing a claim.

To begin, it’s important to differentiate between the two main types of arthritis because you will have a tougher time winning a case with one than the other.

The first kind is osteoarthritis. This is an extremely common joint disorder that we see a lot in older folks, affecting about 20 million people. It’s simply due to normal wear and tear. Pain and stiffness are the most common symptoms, though there is a lot of research to suggest a healthy lifestyle may help improve symptoms markedly. Getting disability benefits for this condition is going to be an uphill battle, though it’s not totally impossible, depending on your age and the severity of the condition.

The second kind of arthritis is called inflammatory arthritis. This is actually an immune disorder in which the system is overactive, thereby resulting in severe joint inflammation that can cause stiffness, pain, swelling and redness. This condition can strike anyone at any age and is also more likely to affect other body systems, including major internal organs such as the heart and lungs. The three types of inflammatory arthritis are:

• Rheumatoid arthritis;
• Psoriatic arthritis;
• Anklyosing spondylitis.

Even in these cases, simply having a doctor’s diagnosis almost certainly won’t be enough to qualify you for federal benefits. The SSA’s listing requires chronic and persistent bouts of inflammation or deformities that affect numerous body systems or significantly restricted movement or other major side effects, such as major involuntary weight loss, malaise or extreme fatigue. You may also qualify if you find that your condition has significantly limited your ability to carry out daily living functions, social functions or carry out tasks in a timely or efficient manner.

The CDC reports that 42 percent of people who have an arthritis diagnosis have some significant limitation with regard to their vital functions, including walking, bending, kneeling, climbing or even just attending basic social functions.

What’s more, a 2011 study found that people who had arthritis – no matter what their age – had a far worse health-related quality of life than those who were arthritis-free. They were more than twice as likely as their counterparts to report “unhealthy days” over the past month.

The CDC reports that roughly 8 percent of people between the ages of 18 and 44 were diagnosed with arthritis. For cohorts between the ages of 45 and 64, the prevalence shot up to nearly 30 percent.

As it stands today, about 50 million adults in the U.S. have been diagnosed with some form of arthritis. In the next 15 years, we’re likely to see that increase by roughly 35 percent to 67 million.

If you are one of those for whom arthritis has significantly limited your ability to function and work, call us today to see about initiating a disability benefits claim.
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The Social Security Administration has proposed a change to terminology with regard to “mental retardation,” in line with Rosa’s Law, which was signed by President Barack Obama in 2010. It is named for a Maryland girl with Down’s syndrome.

Our Boston Social Security Disability Insurance lawyers expect this will have little impact on those seeking benefits under Section 12.05 of the agency’s disability listings. In fact, the move is intended to create distance from the negative connotations of the term with improved sensitivity in mind.

In a proposed rule issued late last month, the agency noted its intention to replace the term “mental retardation” with the term “intellectual disability” in its listing of impairments in evaluating claims involving mental disorders in both children and adults.

The qualifications used to measure this disability would remain the same. That is, the person must display a significantly lower general intellectual functioning prior to age 22. Under this listing, there are four potential measurements.

The first is whether the person has a dependency upon others for basic personal needs such as using the bathroom, eating, bathing or dressing and has an inability to follow directions to the point that taking a standardized test is not an option.

The second is whether that person has a valid Intellectual Quotient (IQ) of 59 or less.

The third is whether the individual has an IQ score of between 60 and 70, as well as some other physical or mental impairment that would create a significant limitation to work function.

And the fourth is whether the individual has an IQ score of between 60 and 70 that results in any of the following: significant restrictions in everyday living activities, difficulties in maintaining social functions, difficulties in concentration, pace or persistence or repeated episodes of decompensation.

The only change would be the way in which the agency refers to these conditions. Rather than “mental retardation” or “mentally retarded children,” the agency listing would say, “intellectual disability” or “children with intellectual disability.”

The terminology change was prompted not only by Rosa’s Law, but by increasing pressure from advocacy groups, such as The Arc, whose CEO was quoted by media as saying that such a move is a critical step in the promotion and protection of basic human and civil rights.

A similar rule was proposed back in 2010, but it was ultimately sidelined. Other agencies have already adopted the new terminology, including the Centers for Disease Control and Prevention. The new terminology won’t be officially used by the SSA any sooner than Feb. 27, as the agency must allow at least a month of public comments before it can be formally adopted.

For many people with this type of disability, SSDI benefits are a lifeline that allows them to sustain their basic needs. Many cannot navigate the process on their own, so advocates and caretakers for these individuals should not hesitate to reach out to a disability insurance attorney who is experienced in working to secure and maintain these critical benefits.
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For all the hype of an over-inflated Social Security Disability Insurance program in the U.S., the number of those applying for benefits last year was actually lower than it had been at any time in the last three to five years.

Our Boston SSDI attorneys know that while some are pointing to this as a sign of economic improvement, it may actually be a sign of widespread discouragement among new applicants.

Consider that while about 50 percent of SSDI applications were approved in 1998, only about 33 percent were approved last year. Part of that could be attributed to the extensively backlogged system, as many applications from 2012 are still pending. But the fact is, it’s getting tougher to win.

According to the Social Security Administration, in 2012 some 2.8 people applied for SSDI benefits, with only about 980,000 being approved. This is the lowest its been since 2008 (for approvals) and 2009 (for applications).

This past year, the U.S. economy added about 1.8 million jobs, pushing the unemployment rate down by more than half a percentage point in that same time frame.

An improved economy might explain the decreased SSDI applications to a small extent. In 2011, the White House released findings from the White House Council of Economic Advisers indicating that Americans between the ages of 50 and 65 who lacked access to a savings of at least $5,000 were more likely to apply for SSDI when their unemployment benefits expired than those who did have access to a sizable savings.

However, what was overlooked in all this is the fact that those who have less of a savings may be more likely to have fewer specialized skills that would allow them to continue working in the event of a disability.

For example, an engineer who suffers a severe physically disabling condition may have an easier time finding and continuing to work – and have a bigger savings account – than someone whose full-time work was in manufacturing.

To be sure, the SSDI process can be an arduous one, made particularly difficult without the assistance of an experienced legal advocate. However, white-collar professionals should not consider the option closed to them.

The key to approval is showing that your condition has rendered you unable to do the work you did before and that you would not be able to adjust to other similar positions. So while physical disabilities may be relatively straightforward, someone whose job requires intense concentration, multi-tasking and organization could potentially claim disability for conditions relating to neurological or mental disorders.

However, these types of conditions tend to require a greater amount of detailed medical proof indicating inability to work. Our SSDI lawyers, having extensive experience in this realm, understand what the administration is looking for and can help bolster your chances of a successful claim.

And applicants shouldn’t necessarily be discouraged by a denial. As the numbers above show, most people who go through the process are denied on their first application. But the approval rating increases for those who take the time to appeal that decision.

Amazingly, most people don’t take this step. If you have already been denied and are considering your next step, an SSDI attorney can help you determine exactly why the claim was denied so that you are better-prepared for the review.
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When it comes to securing disability benefits for a long-term illness or ailment, our Boston Social Security Disability Insurance lawyers know that the wait can be excruciating.

As with many government agencies, the Social Security Administration at times moves seemingly slower than molasses – despite the financial urgency experienced by those working to obtain benefits.

One avenue of relief that may be available to those with certain conditions is a Compassionate Allowance. The administration recently expanded its list, which now includes 200 qualifying medical conditions.

Since October of 2008, some 200,000 people have been approved for SSDI through a Compassionate Allowance. These are individuals with serious diseases who may get approved for a condition in days, rather than the months or years it often takes. Primarily, qualifying conditions include certain types of cancers, brain disorders and a few rare conditions that affect children.

Hiring an SSDI lawyer even for these cases can be beneficial in terms of ensuring you have all the proper paperwork regarding medical exams, treatments and medications to ensure a swift approval.

Among the new conditions approved for Compassionate Allowance as of Dec. 1 of last year are:

These are just a few of the 35 new conditions, and a small fraction of the 200.

The administration reached the conclusion to include these diseases through a process that includes public outreach hearings, counsel of scientific and medical experts, comments to local SSDI offices and research conducted by the National Institutes of Health.

All of these conditions have been found to most likely – just by diagnosis – meet the agency’s definition of disability. Generally, meeting this requirement can come down to subjective interpretation, which is why having a lawyer to advocate your case can be so important.

In determining your case, a reviewer with the administration is going to look at the following:

• Are you able to work?
• Is your condition considered severe?
• Is your ailment among the list of potentially disabling conditions?
• Are you able to do the work you did before?
• Are you able to do any other type of work?

What the agency is looking to determine is whether your condition has already or is expected to last at least 12 months (or result in death) and that it prevents you from working.

Again, this can be subjective, and the administration tends to take a hard line when it comes to whether a person is able to work. For example, a person who is rather educated and worked in a less physically-demanding job may have a tougher time securing benefits than someone who is less educated and whose job history includes positions requiring rigorous physical activity. That’s because the agency will look at whether there is any other type of work you may be capable of doing. Someone with more education will be seen as having more opportunities.

Those with conditions listed in the Compassionate Allowances list may have an easier time overcoming these hurdles, but should still consider hiring an advocate to help ensure their rights are protected throughout the process.
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