Thanks to Anne-Marie:
----- Original Message -----
From: "Anne-Marie Vidal" <shadesofjoy@...>
To: <Undisclosed-Recipient:;>
Sent: Monday, February 10, 2003 3:00 PM
Subject: [invisible-disability] Acquiring and keeping social security
benefits


> From Karen G.
> Hugs,
> Anne-Marie
> No Funds=No Research=No Cure
>
> Acquiring and Keeping Social Security Benefits for CFIDS and FM Sufferers
> (By Alec G. Sohmer, Esq.)
>
> Because chronic fatigue and immune dysfunction syndrome (CFIDS) and
Fibromyalgia (FM) are poorly known medical conditions that are just now
gaining widespread recognition, many sufferers are unaware that benefits may
be available to them - even if they are employed part-time. The inability to
provide for yourself or your family may entitle you to Social Security
benefits. With the proper planning and guidance, it's possible to overcome
the numerous hurdles on the way to winning your claim. An individual who
intends to file a Social Security Disability Insurance (SSDI) claim must be
unable to engage in any substantial gainful activity due to a medically
determinable mental and/or physical impairment, which has lasted, or is
expected to last, at least 12 months or is likely to result in death. A
separate standard applies for a disabled child, as do other income
eligibility requirements. Patients must have supporting medical evidence
from their primary care physician or treating physician. Fortunately,
patients do not have to wait the 12-month period before applying for
benefits, as long as the condition is expected to render them unable to work
for a minimum of that time. There's an important difference between the
eligibility requirements for SSDI and Supplemental Security Income (SSI)
benefits. For SSI, financial resources are considered. A "resource" is
defined as cash on hand, or other personal or real property that an
individual owns or retains an ownership interest in, has the legal right or
authority to liquidate and is not restricted from using for means of support
. For SSDI claims, however, financial resources are not taken into
consideration.
>
> Getting Started
>
>
> The first step in determining your eligibility for SSDI is to
complete and file a written application. You should visit your local Social
Security office for this purpose. Since considerable and specific
information is required, you should visit or call the office beforehand to
determine what supporting documentation is required. Because CFIDS and FM
are not listed as "presumptive" disabling conditions for SSDI purposes,
expect your initial claim to be rejected.
> Presumptive impairments are specific physical or mental conditions
that are so severe that the Social Security Administration (SSA) has
determined that persons suffering from them are considered totally disabled.
If declined benefits, you should appeal. Benefits will be awarded to people
with CFIDS or FM should their symptoms be determined to cause substantially
the same degree of functional limitation as the listed conditions. After
receiving the initial rejection, you must file for reconsideration. The
Request for Reconsideration is the first step in the appellate process, and
requires another application. It is helpful to retain a copy of your initial
application, as the Request for Reconsideration seeks substantially the same
information. Also, you should prepare a detailed list of each and every
physician who has treated you during your illness. The list should include
the physicians' names, addresses, telephone numbers, approximate dates of
treatment and probable diagnoses. Again, be sure to list every physician and
other health care providers you have seen - even those who have not treated
you specifically for CFIDS or FM. Once again, expect a rejection of your
claim. Unfortunately, this is often part of the process for people with
CFIDS or FM. It's time-consuming and frustrating - but don't give up. The
next stage, Administrative Appeal, is where most CFIDS and FM claimants are
successful. CFIDS and FM are not listed among the qualifying conditions in
the SSDI section of the Code of Federal Regulations. So the Administrative
Law judge must determine whether your condition meets or exceeds the
impairments caused by those on the list.
> Under the statute, the judge will determine whether the impairment is
medically equivalent to those listed. Symptoms, signs and laboratory
findings will be compared with the corresponding medical criteria shown for
any listed impairment. All decisions will be based on medical evidence only,
supported by acceptable clinical and laboratory diagnostic techniques. Of
importance, an Administrative Law judge cannot reject a claim based on the
absence of abnormal laboratory and physical findings in your medical
history. This violates SSA policy with respect to CFIDS and FM. The
> SSA has accepted that "there is no dip-stick laboratory test for Chronic
Fatigue Syndrome.so the disease is not per se excluded from coverage because
it cannot be conclusively diagnosed in a laboratory setting. " Hallgring v.
Callahan,
> 975 F.Supp. 84 (D.Mass. 1997) (citing Rose v. Shalala, 34 F.3d 13, 17 (1st
Cir. 1994); Sisco v. Department of Health and Human Services, 10 F.3d 739,
744 (10th Cir. 1993). Further, because the methods for diagnosing CFIDS and
FM are limited, the importance of claimant's testimony and credibility are
enhanced. Reed v. Secretary of Health and Human Services, 804 F. Supp. 914
(E.D.Mich. 1992).
> In a nutshell, that means the judge must weigh your personal word
more heavily than he might in other cases. The Administrative Law judge must
use a five-step, sequential evaluation to determine a person's level of
disability. The judge considers these questions:
> 1) Is the claimant engaging in substantial gainful activity?
> 2) Does the claimant have a severe impairment?
> 3) Does the claimant suffer from an impairment that equals the severity of
a listed impairment?
> 4) Does the claimant possess the residual functional capacity to perform
past relevant work?
> 5) Does the claimant possess the residual functional capacity to perform
any other work that exists in significant numbers in the national economy?
>
> In determining what constitutes a severe impairment, the
Administrative Law judge will consider any condition that significantly
limits your ability to do basic work activities such as walking, standing,
lifting, bending, understanding, remembering, using judgment, etc. Residual
functional capacity is defined as your ability to complete similar
activities despite the functional limitations imposed by your impairments.
> Under the current law, the Administrative Law judge must give the
claimant increased credibility in assessing his or her own residual
functional capacity. Fragale v. Chater, 916 F.Supp.249 (W.D.N.Y.1996).
>
>
> After the award
>
>
> Many claimants question whether they may continue to work while applying
for benefits or attempt work once benefits have been awarded. Many people
wish to work for not only the extra income, but to overcome their
disability. Under the Social Security statute, a claimant may return to work
for a trial period of nine months (not necessarily consecutive) without
interruption of benefits. For a minimum of 36 months after the trial work
period, benefits will continue so long
> as monthly earnings fall below the substantial gainful activity level.
Currently, this level is $700 per month for individuals with disabilities
and $1,170 per month for those who are blind. Even if benefits stop due to
increased earnings, Medicare coverage can continue for at least 39 months
after the trial work period ends. After that, Medicare coverage can be
purchased by paying a monthly premium. Of importance, certain disability
related expenses necessary for work might be deducted when calculating
monthly earnings. Therefore, earnings could be substantially higher than
$700 per month before your benefits are stopped. If you earn more than $700
per month (after deductions) during your period of eligibility, disability
payments will stop. But if you remain medically disabled, benefits may be
reinstated any time during the next 36 months. During this time, benefits
will be received anytime your earnings fall below $700 per month. With
earnings less than $700 per month, benefits will remain indefinitely.
Medicare coverage will continue through the trial work period and for at
least 39 months afterwards, so long as you remain disabled.
> Under the Ticket to Work and Work Incentives Improvement Act of 1999,
claimants receive a "ticket" to use for vocational rehabilitation and other
employment support services. The program is voluntary. While in use,
regularly scheduled medical reviews will be waived. Should work earnings
end, reinstatement of benefits may be requested without filing a new
application. Attorney Alec Sohmer runs a private practice in Brockton, Mass.
He assists individuals and businesses in bankruptcy, real estate, advanced
estate planning, personal injury, small business litigation and Social
Security Disability, specifically helping those with CFIDS and Fibromyalgia.
> Sohmer's Web site deals exclusively with how to apply for disability
benefits, as pertains to CFIDS and FM. He may be reached at 508-583-6510, or
through the Web site: http://www.disabilityassistance.com.
>
>
> 1999 Ruling Aids CFS Claimants
>
>
> In 1999 the Social Security Administration (SSA) adopted a new policy
ruling - SSR 99-2p - recognizing CFS as a potentially disabling condition.
The ruling provides examples of objective evidence, such as high
Epstein-Barr titers and a positive tilt table test, which may indicate CFS.
The ruling also establishes that the applicant's treating physician should
be the primary information source about the patient's medical condition. In
the past, medical evaluators who see the patient only once to render an
opinion on the individual's functional capacity often were given as much
credence as the patient's doctor of record.
> Attorney Mac Sasser has seen improvement in the handling of
CFS-related SSDI cases since the ruling was adopted: "Ruling 99-2p is a big
step forward for people disabled by CFS. This ruling has improved the fact
finding and analysis stages, particularly at the hearing level. "Association
president & CEO Kim Kenney seconds Sasser's observation. "CFS cases are
decided more quickly and more often in favor of the applicant than before,"
Kenney says. "SSA is gathering data from its offices around the country to
assess approval rates and identify geographic differences that alert staff
to the need for additional training on CFS."
> The CFS ruling is available at
www.cfids.org/resources/ss-disability.asp. If you have been diagnosed with
CFS and are filing for benefits, make sure the ruling number, 99-2p, is
noted in your application. - The CFIDS Association of America
>
>
> Tips to minimize your wait
>
>
> Although the appellate process for Social Security Disability
Insurance benefits may take as long as two years from start to finish -
excluding the time spent for diagnosis - there are measures that can reduce
delay:
> Get started now.
> Prepare a list of each and every physician you have seen. This list
should include names, phone numbers, addresses, approximate dates of
treatment and probable diagnoses. Remember to include all physicians,
whether or not related to CFIDS or Fibromyalgia.
> Keep documents of medical records, and note how the condition affects your
functional capacity on a daily basis.
> Document all necessary work expenses related to your disability.
> Talk to an experienced attorney who understands both the condition and
Social Security laws.
>
>
>
>
>
>
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>
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