Massachusetts Social Security Disability Lawyers Blog

A working group at the National Cancer Institute has recommended sweeping changes in the way we detect, diagnose and treat cancer.

Our Boston Social Security Disability Insurance attorneys have some concerns regarding these recommendations, particularly as they relate to diagnoses. We know that while many cancer patients are eligible for federal disability benefits, those who aren’t given a definitive medical diagnosis may be at a substantial disadvantage when it comes time to apply for this financial help.

While these folks may still qualify for benefits, based on how their medical condition has affected their day-to-day functions, not having all the proper paperwork could negatively impact their chances. Even if these individuals are later diagnosed, the delay could mean a significant delay in benefits.

The position taken by the NCI working group, published in the July 2013 edition of the Journal of the American Medical Association, was that the word “cancer” be eliminated entirely from certain common diagnoses.

For example, there are some premalignant conditions, such as a form of breast disease known as ductal carcinoma in situ, that most doctors concede is not actually cancer. The working group says that the condition should be renamed by eliminated the word “carcinoma” so that patients are less afraid and less likely to seek out treatments that may not be necessary and that could be potentially harmful. In the case of ductal carcinoma in situ, that could mean removal of the breast through surgery.

The group also contends that many of the lumps and lesions found during cancer screening exams for lung, thyroid, prostate and breasts should not be called cancer. Rather, they should be labeled as “IDLE” conditions, which is short for “indolent lesions of epithelial origin.”

The group holds that the word “cancer” should be strictly reserved for describing those lesions or lumps or tumors that have a “reasonable likelihood” of killing you if left untreated.

We can certainly understand that doctors don’t want their patients to panic. However, there are other ways to accomplish that, and there are many medical experts who disagree with this new radical approach being proposed. Just because a disease isn’t lethal doesn’t mean it doesn’t have the power to significantly impact your life and well-being.

The research was born out of the fact that our ability to detect these conditions has advanced at a rapid clip. This is important because early detection of rapidly-advancing cancers is often key to survival. What this also means is that slower-moving cancers, which might not have been detected with the technology available even just a few decades ago, are now visible.

The working group says that once a patient knows there is a cancerous growth, they are apt to want to act on it, even if it is unlikely to cause them significant harm for many years.

But shouldn’t it be the patient’s choice to make an informed decision? By calling cancer anything other than what it is, would the medical community be putting patients at a disadvantage?

Look at Actress Angelina Jolie, who recently chose to go public with her decision to have a double masectomy because she learned through genetic testing that her risk of breast cancer was extremely high. She did not even have cancer, and made the decision to be treated proactively. Having lost her mother to cancer at an early age, it was a risk she did not wish to take.

Not everyone has those kind of resources – or that kind of insurance. But stripping people of a cancer diagnosis, when there is clear evidence that this is what they have, may also rob them of the choice to take proactive measures.

According to the American Cancer Society, half of all men and one-third of all women in the U.S. will develop cancer at some point during their lives. We are not talking about a minor-impact decision.

At the very least, we hope that any such changes will not be rushed.
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Charity runs and ribbons and awareness fliers are common for a number of ailments, including breast and prostate cancer.

Certainly, those are worthwhile causes. However, our Boston Social Security Disability Insurance attorneys recognize that kidney disease, which garners far less attention, actually affects more people and kills more Americans than these other conditions combined.

Kidney disease results in some 90,000 American deaths annually.

In cases where it’s not fatal, the cost of treating end-stage kidney disease, either with a transplant or through dialysis, is through the roof – more than five times what Medicare pays annually for the average patient over the age of 65, according to a recent report by The New York Times. Many of those who are living with the condition are no longer able to work.

This is where SSDI benefits become a critical lifeline for people. Because while we know quite a bit about who is most at risk, how it can be prevented and even how we can halt its progression in the earlier stages, all of this does little unless people are tested. A lot of doctors fail to conduct simple, inexpensive tests for about three-quarters of those who are most at risk for poor kidney functions. That means most people generally don’t find out there is a problem until it’s the disease is in its most advanced stages.

It’s estimated that more than 25 million Americans have kidney disease, but many of them don’t yet know it. Another 75 million are at risk of developing it.

The American Journal of Kidney Disease in April published a study showing how common lifestyle factors can harm the kidneys. Researchers combed some 15 years’ worth of data involving about 2,300 young adults. What they found was that individuals who smoked, were overweight and had diets low in fruit, nuts, whole grains and dairy and high in sugary drinks, sodium and red meats were at the greatest risks. Only 1 percent of people who had none of these risk factors developed the disease.

The group deemed at the highest risk was African Americans who had high blood pressure, diabetes or a family history of kidney disease and who regularly consumed fast food, red meat and sugary drinks.

People who are suffering from end-stage renal failure generally will qualify for SSDI benefits. As outlined in Sections 6.02 and 6.06 of the Social Security disability listings, a person with this condition will qualify for benefits if he or she has:

• The need for regular dialysis;
• Undergone a kidney transplant;
• High levels of creatine with symptoms of damage;
• Nephrotic syndrome.

The administration is likely going to ask for an extensive background of your medical history that is going to include records of all your hospitalizations, laboratory findings and medical treatment notes. Any evidence that shows a continued deterioration of your kidney’s function will be important as well.

Even if you are unsure about whether your condition may qualify you for benefits, it won’t hurt to consult with an experienced SSDI attorney to help you determine your odds.
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The average 20-year-old has a one-in-five chance of becoming disabled at some point during their professional lives, according to the Social Security Administration.

However, those figures rise as we age.

Our Boston SSDI attorneys know that the fear of aging is not so much about the number of candles on the cake but the tasks we’ll no longer be able to complete. Unfortunately, those challenges come much earlier than we might have hoped.

The New York Times recently explored the as-yet unattained “compression of morbidity” plateau, whereby we remain active and healthy as we age until our bodies reach their limit, fail and die quickly.

But it’s not happening that way, in fact not for most people. It’s true we’re living longer, but we’re paying for that in a way with extended disabilities that stretch far into old age. In the U.S., we’re seeing this greatly amplified by the fact that one of our largest generations is now reaching its golden years.

So while political power players and media pundits harp on the growing number of those claiming SSDI, this was, in fact, fully expected, though it’s true we had hoped to some extent to avoid it with the help of modern medicine.

A recent study conducted by the University of California, San Francisco, sifted through 15 years’ worth of data from the federal Health and Retirement Study to figure out what the disability rates were for those in the final two years’ of their lives. What they found was that in spite of huge investments in geriatric medicine, while we can in some cases slow or delay disability, we haven’t yet been able to prevent it.

Most people who live into old age do so with some type of mobility or disability. Women are especially at risk, mostly because they live longer.

Of 8,200 adults over the age of 50 who died between 1995 and 2010, researchers found that nearly a third were disabled in the last two years of their lives. Disabled was defined as requiring assistance with basic daily tasks such as dressing, bathing or using the toilet. Twelve percent of those were listed as severely disabled.

The rate of disability ticked up with age. Those who passed away between the ages of 50 and 69 had a disability rate of 15 percent. Those who died after the age of 90 had a 50 percent chance of being disabled.

The biggest problem appeared to be mobility. Nearly 70 percent of those surveyed had trouble walking more than a few blocks in the two years prior to death. Nearly half had trouble walking a single block and more than half reported struggles in climbing a single flight of stairs.

This study focused only on physical disabilities. It’s worth noting that a number of cognitive impairments can also impact your ability to work – equally if not more so.

Depending on your exact age, you can anticipate collecting Social Security old age benefits sometime between ages 65 and 67. If you become unable to work before that point, this is when you can turn to SSDI. It may only be a few years before those benefits are then rolled over to the old-age system, but for many people, this is a critical transition.
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A new report by the National Center for Health Statistics indicates that the racial disparity between white and black Americans as it relates to life expectancy has narrowed significantly in the last eight decades, but we still have a long way to go.

According to the report, there remains a four-year difference, and the reasons primarily relate to higher rates of heart disease, cancer, diabetes, infant mortality and homicide among black Americans.

As it stands now, life expectancy for blacks rose to 75 years in 2010. That’s up from 64 in 1970. For white Americans, life expectancy is up to 79 years, from 72 years in that same frame of time. It’s a significant departure from 1930, when the life expectancy was 60 for whites and 48 for blacks.

Our Boston Social Security Disability Insurance lawyers know some of these factors occur very suddenly. However, three of those – heart disease, cancer and diabetes – often have a slower onset and can become chronic conditions that often result in people being unable to work for extensive periods of time.

The fact that people are living longer makes these benefits all the more critical.

Heart disease was reportedly the single biggest factor in the difference, accounting for a full 3.8-year difference between the two races. The second-biggest factor was cancer.

The term “heart disease” encompasses a wide variety of cardiovascular diseases and problems that afflict the heart and surrounding tissue. Depending on the condition and its severity, it can absolutely qualify a person for SSDI benefits.

The three most common types of heart disease that we find qualifies individuals for benefits are: coronary artery disease, congestive heart failure, arteriosclerosis and aneurysm.

Coronary artery disease is a condition that occurs when the arteries become clogged and narrowed and blood flow to the heart is restricted. Without enough blood, the heart becomes starved for oxygen, which then results in a cramping of the heart muscle.

Congestive heart failure is a condition wherein blood returning to the heart from the veins becomes backed up, due to the heart’s inability to pump blood effectively to the body’s other organs. Swelling is known to occur with this condition and it’s known to also significantly impact kidney and lung functions.

Arteriosclerosis is also sometimes referred to as a hardening of the arteries and results when calcium or fat deposits on the artery walls result in a thickening of these arteries. This can result in a heart attack.

Aneurysm is a bulge in the artery stemming from weakness in the wall of the blood vessel. A rupture of this could result in fatal bleeding.

With regard to diabetes, generally if your condition can be controlled through diet and medication, you won’t qualify for disability benefits. However, if the condition is uncontrolled and it’s prevented you from working for the last year, you may very well be eligible.

Various forms of cancer will also qualify you for benefits as well, but again, it will depend on the severity of the cancer and to what extent it has rendered you unable to work.

In terms of addressing and preventing these issues long-term, policy makers advise specifically redoubling on efforts to curb smoking, poor diet and hypertension among black populations and also ensure that they have access to effective medical treatments.
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Chronic obstructive pulmonary disease, which refers to a series of diseases that cause airway blockage and breathing problems, is the third-leading cause of death in the U.S., according to the U.S. Centers for Disease Control and Prevention.

And yet, our Boston Social Security Disability Insurance lawyers know that rarely will you see a “march for the cure” crusade or a campaign with colored ribbons and corporate sponsors. There is a stigma associated with these conditions and a sense that somehow, people with COPD deserve it.

Medical professionals say there is this sense that “you did this to yourself,” and therefore your suffering is less worthy of aid.

It’s true that smoking accounts for most cases of COPD in this country. However, we should first of all remember that those who are now suffering from COPD didn’t have all the information we do know about the dangers of smoking when they started. It was frequently advertised not only as cool, but in some cases outrageously even as a healthy stress-reliever.

Also, many cases of COPD are under-diagnosed and under-treated, according to the director of critical care medicine at the University of Texas Medical Branch in Galveston. He was recently interviewed by the New York Times regarding his latest research on COPD patients. The study, published in the American Journal of Medicine, indicates that the number of hospitalizations for COPD patients has dropped off significantly.

Researchers say this translates to overall better care for COPD sufferers. These individuals are frequent hospital patients, particularly when their diagnosis is compounded by also suffering from other diseases simultaneously, such as diabetes, heart disease and osteoporosis. The average COPD patient is known to be admitted to the hospital up to three times annually.

What the Texas researchers recently analyzed was the experiences of more than 190,000 patients between 1999 and 2008. What they found was that overall hospitalizations fell by nearly 20 percent. Among those with two or more acute exacerbations that required hospitalization, the number had dropped by nearly 25 percent.

It’s not a matter of fewer people being afflicted with the disease. While it’s true that reduced rates of smoking will eventually lead to this, we’re not there yet.

Rather, we’re looking at a situation where people have access to better medications, better treatments and doctors who have an overall more comprehensive understanding of how to improve patients’ lives.

Other factors that may have led to some reduction in the hospital rate for COPD patients is increased use of the flu vaccine, as well as legislation that has helped reduce exposure to second-hand smoke – both of which could serve to aggravate someone’s COPD.

Still, even with these improvements, there are many with COPD who have been rendered unable to work. The Social Security Administration does list COPD as a disabling condition, with the impairment listing detailed in Section 3.02 Chronic Pulmonary Insufficiency.
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The American Medical Association recently made headlines by formally declaring that obesity is a disability.

Already known to be a serious health issue, the ruling is intended to force the medical community to peer beyond the cosmetic consequences and delve into territory they may have otherwise made them uncomfortable in order to confront the serious short- and long-term medical consequences of being overweight.

Our Boston Social Security Disability Insurance attorneys know that what this won’t do is give an automatic pass for federal benefits to anyone who is overweight. What we hope it will accomplish, in addition to improving the dialogue between physicians and patients, is to lend a greater legitimacy to claims of disability for those who are morbidly obese to the point that it has become debilitating.

Many don’t realize it, but obesity used to be listed as an impairment in the SSA’s blue book listing of impairments. However, it was removed in 1999. At the time, the reasoning was that many individuals who are obese (defined as having a body mass index of 30 or higher) have the ability to lead productive lives that includes gainful employment.

In fact, it’s a condition experienced by one-third of adults and 17 percent of children (78 million and 12 million, respectively).

Not all of them are going to be able to get benefits.

You can still obtain disability benefits for obesity. But the administration is going to base the decision on whether your limitations are equal to those in other impairment listings, or whether it causes or significantly contributes to other listed impairments.

This is where the AMA’s ruling can help tremendously.

It means that patients are more likely to be having these discussions with their doctors. Previous research has found that more than half of all obese patients have never been informed by their doctor that they are obese. Declaring obesity a disease means that doctors have a professional obligation to diagnose and treat it. The sooner a person is formally diagnosed, the more extensive the documented medical history, which is critical in SSDI claims.

The new designation is also associated with a steep incline of obesity-related diseases over the last three decades. Cardiovascular disease, Type 2 diabetes, stroke, joint disease, and certain cancers (breast, colon, esophagus, kidney, pancreas, gallbladder and thyroid) – all of which are partly or largely attributed to obesity – cost some $150 billion in medical expenses. Projected increases could result in raising that figure by an additional $550 billion over the next two decades, according to a recent study by Duke University.

Earlier medical intervention will hopefully mean that these costs, as well as federal disability rolls, will eventually level off.

But in the meantime, this ruling could mean more claims citing obesity will ultimately be approved.
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There is a misconception that depression is a minor ailment, something that is “all in your head” or reversible with a simple outlook adjustment.

Our Boston Social Security Disability Lawyers recognize it for what it is: a chronic, clinical impairment that in some cases is not only incredibly debilitating, but sometimes fatal. In fact, research has shown that 15 percent of those diagnosed with depression – or one out of every six – will commit suicide at some point. Many more will attempt it.

Treatment isn’t always effective, even when followed to the letter. For many, it’s a lifelong struggle. That’s why the Social Security Administration has taken care to formally recognize it in its impairment listings, specifically Section 12.04 under Affective Disorders. In order to meet the listing, one must have been diagnosed by a medical doctor with depressive syndrome which has been medically-documented in its persistence as having been accompanied by a combination of four of the following:

• Anhedonia, or pervasive loss of interest in almost all activities;
• Changes in weight or appetite disturbances;
• Sleep disturbances;
• Psychomotor retardation or agitation;
• Decreased energy;
• Feelings of worthlessness or guilt;
• Difficulty thinking or concentrating;
• Hallucinations, paranoid thinking or delusions;
• Suicidal thoughts.

These must be accompanied by at least two of the following:

• Significant restriction of daily living activities;
• Significant trouble maintaining social function;
• Significant trouble keeping concentration;

Or, a documented history of chronic affective disorder lasting at least two years that has limited work functions and has been accompanied by at least two of the following:

• Repeated episodes of decompensation, each of an extended duration;
• Residual disease process resulting in a situation where even marginal increase on mental demands or changes to the environment would result in decompensation;
• A history of a year or more of inability to function outside of a highly-supportive living arrangement.

Recently, The New York Times published an article regarding a new approach to depression that many doctors are exploring. It’s called transcranial magnetic stimulation. It uses magnetic pulses to stimulate certain parts of the brain believed to be involved in mood regulation. Unlike electro-shock therapy, this kind does not produce seizures. It’s approved only for patients whose use of antidepressant drugs has proven ineffective.

Of course, this kind of treatment is in its infancy. The American Psychiatric Association’s practice guidelines say the benefits of TMS are “relatively moderate.”

Other forms of treatment, such as medications, can have a number of debilitating side effects just on their own. We understand that treating depression is not as simple as taking a pill. It’s an ongoing, daily struggle. For those who have been rendered unable to function or work as a result, there is help available.
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For some people, Social Security Disability Insurance benefits will be the only hope of financial survival until they reach 65 and begin receiving their Social Security retirement benefits.

But our Boston SSDI lawyers know that especially for those who are younger when they began receiving the benefits and whose condition isn’t necessarily permanent, there is a desire to someday return to work when possible. The fear that they may be unable to do so could fuel trepidation to reach out for help in the first place, even as their ability to work rapidly diminishes.

There is widespread recognition that going back to work after a period of disability isn’t all that simple.

But there is good news that should ease applicants’ minds. It’s called the Ticket to Work program. It’s voluntary and free and available to anyone between the ages of 18 and 24 who receives SSDI or SSI benefits.

The goals of the program are as follows:

• Offer SSDI beneficiaries with disabilities more choices when seeking help in re-entering or maintaining employment;
• Gradually helping to increase self-sufficiency and financial independence for those with disabilities;
• Whenever possible, reducing the individual’s reliance on disability benefits.

As of the end of May, there were approximately 321,000 people throughout the country enrolled in the Ticket to Work program.

It is true that if you continue to work while awaiting approval for disability benefits, you could have a difficult time securing benefits. That’s because the whole point of the program is to extend benefits to those who can’t work or won’t be able to work for at least a year. We understand the financial burdens associated with waiting months without any income, but it’s critical for applicants to discuss their employment status with a qualified SSDI attorney before they even apply to determine whether your job could sabotage your chances of successfully obtaining benefits.

On the other hand, you won’t automatically lose your benefits if you begin working after they’ve been granted. But again, you may want to at least review your plans with your SSDI attorney before you embark on the Ticket to Work program or any quest for employment. Going back to work from a disability is tough. Some people who try are going to find that they are still not well enough to return. What the Ticket to Work program allows is for SSDI recipients to test their ability to work for up to nine months without losing their benefits, regardless of how much you earn.

After that nine months, you can also seek a special status for 36 months, during which time you can continue to receive benefits for any month for which your earnings don’t top $1,040. If you earn more than that, your benefits can be suspended for that month (unless you are blind, in which case your benefit ceiling is $1,740).

You are also promised during this time that you will be able to retain your Medicaid or Medicare coverage. Additionally, the SSA won’t trouble you with a Continuing Disability Review, which could result in the potential revocation of benefits.

If you are mulling a decision to go back to work after you have already secured your SSDI benefits, talk first with an experienced SSDI lawyer who can be your advocate as you navigate the process.
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