Tuesday, August 3, 2010

Proving Disability in SSI and RSDI Cases

To be found disabled, you must be unable to do any substantial work because of your medical condition(s), and your medical condition(s) must have lasted, or be expected to last, at least 1 year, or be expected to result in your death. (see the Social Security website)

One of the most common questions that claimants have regarding their disability cases is how to prove their disability most effectively. At hearings, my admonition to clients and their supporting witnesses is to always tell the truth, but do so in the light most sympathetic to their cause. However, in the interest in resolving cases at a point earlier than a hearing, the biggest difference-maker in proving disability is the level to which medical records may convince an adjudicator of one's disability.

To that end, here are my cornerstones of medical evidence. Of course income and financial means will often bear on the quality of medical care (and as such medical records) available, but these should always be in the back of a claimant's mind as they interact with their caregivers. Failure to meet the standards herein may not doom a case to failure, but success in meeting these standards will certainly make proving disability a more clear-cut affair.

Strength of Opinion - The most vigorous opinion regarding a claimant's disability should come from their own doctor. This can often be summarized in a letter of disability or an RFC (residual functional capacity) report that the claimant's physician may fill out, but it should also be a recurring thread in treatment records. Notations and recommendations that the claimant must curtail daily activities, and notations of specific life-limiting symptoms from the condition or the treatment are very helpful in examining a case.

Continuity of Care - Another helpful feature that can help cases succeed is demonstrable continuity of care. If a claimant has seen a physician for the entire course of their illness, there is an implied level of credibility that may be inferred, especially where symptoms worsen. Continuity of care may be established through regular treating physicians, or in the cases of indigent persons who cannot privately source and schedule care, it may take the form of ER records. Regular visits to the ER for emergency care related to a claimant's illness can convey a level of continuity of symptoms that may be convincing as well. This is not to suggest that claimants should visit the ER for every minor medical symptom, but in the cases of true medical emergencies, EMTALA will require that the hospital treat a patient, regardless of factors such as insurance coverage, etc.

Number of Opinions - Most people seek a second opinion when dealing with medical challenges. In disability cases, many diseases that claimants experience are specialized to a particular body system. As a result of this, it is very helpful not only for a patient's primary care doctor to opine on a heart condition (for example), but also to seek opinion from their cardiologist. Certainly the admonitions regarding continuity of care, and strength of opinion noted above bear on the inclusion of these records in case evidence, but ultimately, the more professional, provable, and unbiased opinions that may be offered on a claimant's behalf, the more provable their case becomes.

No Interfering Opinions - The previous points represent ideals that patients should seek when building their record of disability. This final point represents an ideal to be avoided. In interacting with the physicians that treat them, claimant's should make every effort to avoid behavior that could cause their treating physicians to doubt their symptoms or word. Two major classes of such damaging opinions are of particular concern: malingering and substance abuse. Malingering is the fabricating or exaggerating the symptoms of mental or physical disorders for a variety of secondary gain, in this case the gain might be prescriptions, drug benefits, or even continued treatment. Malingering can cause additional challenges to a case because the testimony upon which a claimant should most desire to rest on is the indirect testimony made my their physician records. If those records do not support disability, or create doubt as to its existence, cases become much more complex. Allegations of substance abuse are are much more directly damaging to a case. Though this is a very complex issue that cannot be fully addressed in a note such as this, it is important to note that Social Security will look at the impact that the abuse has on a given medical condition, and may disregard that condition when evaluating a claim if it believes that ceasing the abuse of the substance will cause that condition to improve.

In summary, with regard to claiming disability, it is important to view medical records as claimant testimony, and do everything to ensure that medical records operate as case support, rather than create additional obstacles to overcome.

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