Social Security Disability and Back Problems, Arthritis and, other Musculoskeletal-Orthopedic Impairments
The Social Security Disability program can be complex, confusing and, frustrating. This article will help to simplify the program for those with musculoskeletal/orthopedic conditions.
In regards to ortho. related problems, the more common allegations deal with back problems, arthritis, amputations and, fractures. The program covers everything however.
You can't be working at the time you apply. Ok, technically you can work up to a certain dollar amount but your ability to work, even part time, will weigh against you...unless you are obviously disabled...like wheelchair bound for life. Your condition has to be expected to last for 12 months or longer and/or to result in death.
If eligible, your claim will be forwarded to a Disability Determination Office in the state in which you live. Sometimes there is one office in the state and sometimes multiple. Once the adjudicator gets your claim, they will contact your treating sources for medical records. If they cannot obtain enough current-recent medical records a consultative exam will be scheduled at no cost to you. They can arrange transportation (taxi service, bus tickets, etc.) if you have no way to get to your exam.You must cooperate with the process or you will likely be found not disabled due to failure to cooperate or insufficient evidence.
X rays and other imaging studies are important as are testing for range of motion, strength, reflexes, and gait. A need for an assistive device is in your favor but don't fake it cause experienced Ortho. doctors can tell. If you fake it then you can be sent to fraud, subject to surveillance and, prosecuted.
Two amputations are generally an automatic allowance. People who are permanently wheelchair or bed bound are allowed. A leg amputation with inability to effectively use a prosthesis is generally allowing. A leg fracture which does not heal within 12 months and which results in an inability to effectively ambulate can allow. Major problems with both upper extremities resulting in inability to perform fine and gross movements is generally allowing.
If not allowing by itself your impairment can still factor into a finding of disabled based upon other medical and vocational factors. For example, you may also have diabetes and a heart condition which restricts your ability to function. These impairments combined with your orthopedic problems can result in your claim being approved.
Your age is VERY important. Ages 50, 55 and 60 are especially important. The program is weighted to favor older folks which makes sense. A 42 year old can be denied but a 55 year old with the same condition can be allowed. Other non medical issues such as educational level, work history and, ability to speak English can come into play.
Once enough evidence is received your claim will be forwarded to a medical consultant. The consultant will determine your residual functional capacity in accordance with Social Security guidelines. The claim will then go back to the adjudicator who will perform additional analysis. It is the adjudicator who will ultimately make and input the decision.
To save money, a few corrupt states mostly bypass the medical consultant and have the adjudicator with a Bachelors Degree assume most of the role of medical consultant. Be very scared! This is called Single Decision Maker and is a twisted perversion of the program. In these states the medical consultant use to be a bonafide, legitimate doctor. Now it is primarily a person who never went to medical school, who has never prescribed medication and, who has never treated a patient. During the claims process you should ask your adjudicator if the state is a single decision maker state. If it is (hopefully they will tell you the truth) you should have little to no confidence in the program and if denied should definitely appeal. The "Single Decision Maker" crime happens mostly in the NW part of the nation i.e. Washington, Oregon, Idaho, Alaska...
Due to this scandal some of these states eliminated the phrase "Single Decision Maker" but still maintain the practice. So, if you ask them if they are a Single Decision Maker state they can say no when really they still are.
If you are denied you have x number of days to file an appeal. Your claim will then be reconsidered. The reversal rate is low. If you are denied again and if you appeal you then go to the third level before a judge.
The program is interpreted differently at this level in a way which is VERY favorable to you. The judges take note of all the objective findings of course but focuses more on the subjective at this level than at the prior two levels. Examples of subjective variables are pain, fatigue, etc.
The judges often get lost in historical court case precedents and lots of other legal mumbo jumbo. The judges like to pontificate to prove to everybody how smart they are. Aside from possibly annoying or boring you this does you no harm--be quiet and let them pontificate!
The bad news is it takes well over a year to get before the judge...often much more than a year. Sixty to seventy percent of all claims are reversed to an allowance at the third level. Don't try to make sense out of some of these things or you will lose your mind. You do not need an attorney or an attorney representative (like Allsup) at the first and second level but definitely do at the third level.
There are many other nuances and complexities but I've covered quite a bit of the basics herein.
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