Information obtained from internet when adjudicating cases

With the increased popularity of the internet and various social media websites, many people may be wondering  how the information they post on the internet may effect their claim for Social Security Disability Insurance benefits (SSDI) or Supplemental Security Income (SSI).

Fortunately, the Social Security Administration (SSA) has included a new section in the Hearings, Appeals and Litigation Law (HALLEX) manual regarding the use of information obtained from the internet when adjudicating cases. Generally, an Administrative Law Judge (ALJ), as well as other staff within the hearing office, may not rely on information from the internet unless it has been verified by a Cooperative Disability Investigations Unit (CDIU).

The ALJ, along with other hearing office staff, are not to conduct independent searches for information about claimants on the internet. If this were done, it could compromise an individual’s personally identifiable information (PII). ALJ’s, as well as other SSA officials, have a duty to protect PII at all times- including while off duty. If, while adjudicating a claim, an ALJ comes across information from the internet that was entered into the record by a SSA or state agency employee at an earlier level in the process, the ALJ will not consider that evidence.

There are, however, some situations in which an ALJ may consider information from internet sites. These include situations in which the information has been verified by the CDIU and associate with the record, and also when the information was submitted by the claimant or the claimant’s appointed representative. If a disability claim reaches the Appeals Council level, the case analysts are to abide by a similar set of rules regarding information obtained from the internet.

For more information, the sections of HALLEX regarding information from the internet can be accessed here: https://www.ssa.gov/OP_Home/hallex/I-02/I-2-5-69.html

The disability claim adjudication process can be a lengthy and intricate one, and not something you should undertake without an attorney. Feel free to call our office should you have any questions.

Multiple Sclerosis, or MS, is a neurological disorder that frequently effects an individual’s ability to engage in gainful activity. It can be disabling while at other times, an employee with MS may seek an accommodation under the ADA.

If you have MS and file a claim for disability benefits, the Social Security Administration (SSA) will evaluate the severity of your disorder under listing 11.09 of the Impairment Listing Manual.   Listing 11.09 is divided into 3 paragraphs: A, B and C. Paragraph A provides criteria for evaluating disorganization of motor function, a symptom characteristic of a diagnosis of MS. Paragraph B references other listings for evaluating visual and mental impairments caused by MS. Finally, paragraph C provides criteria for evaluating the severity of an individual with MS’s impairment when there is no muscle weakness at rest, but develops on activity due to fatigue.

The disorganization of motor function required to meet the severity level of Listing 11.09A is described in paragraph 11.04B. To satisfy Listing 11.09A, disorganization of motor function associated with MS must be significant and persistent in at least two extremities, and result in sustained disturbance of gross and dexterous movements, or gait and station. Some examples of this disorganization of motor function include paralysis, tremors, or other involuntary movements. See paragraph 11.00C for more about the definition of “disorganization of motor function.”

A diagnosis of MS can result in various mental and visual impairments. An individual experiencing these types of symptoms will be evaluated under listings 2.02, 2.03, 2.04, or 12.02 rather than the traditional MS Listing 11.09. Sometimes the limitations in motor function of a person with MS will be present when that person is engaging in some type of activity, but not when that individual is resting. These types of cases are evaluated under paragraph 11.09C. The impairment in motor function must be reproducible upon a physical examination.

As with any claim, it is important that the person seeking benefits is receiving ongoing, regular medical treatment. In order to meet the severity level of listing 11.09, an individual’s limitations must be well documented by a doctor.  Even if your conditions do not meet the severity outlined in listing 11.09, you may still be eligible to receive benefits if your conditions result in your inability to function or maintain work skills. Please feel free to call should you want to discuss these issues further.

Heart failure (CHF) is a condition that effects the heart’s ability to pump enough blood to body tissues, and may effect a person’s ability to work and entitle that person to receive disability benefits. There can be multiple causes of CHF, including hypertension, cardiomyopathy rheumatic, congenital, or other heart disease. To qualify as disabled for chronic heart failure, the Social Security Administration analyzes it under Listing 4.02.  In order to meet the severity level under listing 4.02, an individual must meet the criteria of both parts A and B of that listing. Both of the two main types of heart failure (predominant systolic dysfunction and predominant diastolic dysfunction) are reviewed under this regulation.

Meeting the criteria in part A of Listing 4.02 requires a showing of either systolic or diastolic failure. Systolic failure requires evidence of left ventricular end diastolic dimensions greater than 6.0 cm or ejection fraction of 30 percent or less during a period of stability. Diastolic failure requires evidence of left ventricular posterior wall plus septal thickness totaling 2.5 cm or greater with an enlarged left atrium greater than or equal to 4.5 cm, with normal or elevated ejection fraction during a period of stability.

Meeting the criteria in part B of Listing 4.02 requires that an individual’s CHF results in at least one of several specific symptoms which are outlined in parts B(1)-(3) of that listing. To satisfy part B(1), an individual must show that the symptoms of CHF result in a significant inability to independently initiate, sustain and complete activities of daily living. To satisfy part B(2), an individual must show that they have had three or more episodes of congestive heart failure within a consecutive twelve month period. Finally, satisfying part B(3) of listing 4.02 requires that an individual demonstrate an inability to perform an exercise tolerance test at a workload equivalent to 5 METs or less.

As with any claim for disability benefits, it is important that you receive proper treatment for your conditions. This is particularly important for heart conditions, as most of the evidence considered by SSA in these types of claims will be objective test results. Even if your conditions do not meet the severity outlined in listing 4.02, you may still be eligible to receive benefits if your conditions result in your inability to function or maintain work skills. Our attorneys deal with these complicated issues on a frequent basis and with a high success rate.  Feel free to call if you want to discuss these issues further.

Seizures and Epilepsy are neurological disorders that affect a person’s ability to perform tasks, sometimes even simple tasks, and leave many individuals unable to work. The Social Security Administration (SSA) classifies Epilepsy as a neurological disorder under Listing 11.02 and 11.03 of the Impairment Listing Manual. We say individuals with purpose here as there are many types and levels of seizures, and they have a wide variety of effect on that individual.  Disability applicants certainly can receive benefits but SSA bases a determination on the severity and frequency of the seizures, potentially in combination with other health issues.  Social Security will first examine the frequency, duration and severity of the applicant’s seizures. To meet Listing 11.02 for convulsive epilepsy, grand mal, seizures must occur more frequently than once a month. To meet Listing 11.03 for nonconvulsive epilepsy, petit mal, seizures must occur more than once weekly. Both Listings require that the applicant have frequent seizures despite at least 3 months of prescribed treatment. The applicant must also show that at least one seizure meets the detailed description of a typical seizure. This includes tongue bites, injuries associated with attack, postical phenomena, presence or absence of aura, and sphincter control.  https://www.ssa.gov/disability/professionals/bluebook/11.00-Neurological-Adult.htm

The applicant also plays an integral role in the success of winning a disability claim based on seizures.  The applicant should keep a written diary to document the frequency and severity of seizures. Further, the applicant must stay compliant with prescribed treatment and medical advice in order to prove that the 3 month prescribed treatment requirement is fulfilled. Further, consistent medical treatment can help win the case because Social Security also analyzes the aftermath of seizures. Medical records document how the seizure affects the applicant afterwards and can help prove the claimant’s inability to sustain gainful employment.

If the applicant’s seizures and epilepsy are not severe enough to meet Listing 11.02 or 11.03, it is still possible that the seizures, along with other disabling conditions, prevent the applicant from sustaining gainful employment.

Knee, elbow and pain in any major joint, no matter the cause, can severely limit your  daily activities but also your ability to work. Disability issues for joint pain and dysfunction are categorized under Listing 1.02.  In order to qualify, you must show an anatomical deformity in the effected joint, along with chronic pain or stiffness that limits the range of motion and functioning of the joint. You must also be able to show signs of joint space narrowing, bony destruction, or ankylosis of the affected joint through medically acceptable imaging, such as an x-ray.

Listing 1.02 also distinguishes between major weight bearing joints like the hip, knee, or ankle, and major peripheral joints in upper extremities like the shoulder, elbow, or wrist. In order to meet listing 1.02(A), your condition must meet the above conditions and involve at least 1 major weight bearing joint resulting in your inability to ambulate effectively. In order to meet listing 1.02(B), your condition must meet the above conditions and involve at least one major peripheral joint in each upper extremity, resulting in your inability to perform fine and gross movements effectively.

The inability to ambulate effectively and the inability to perform fine and gross movements effectively are not general terms, but rather specific criteria defined by the SSA. For an explanation of what it means to not be able to ambulate effectively or to not be able to perform fine and gross movements, please see sections 1.00(B)(2)(b)-(c) of the Impairment Listing Manual here:  https://www.ssa.gov/disability/professionals/bluebook/1.00-Musculoskeletal-Adult.htm#1_02

As with any claim for disability benefits, it is important that you get appropriate medical treatment for your conditions, and one must also recognize that these issues are not viewed in isolation.  Our clients typically have other medical issues that also effect their ability to work.  . Even if your conditions do not meet the severity set forth in this listing, you may still qualify for benefits depending on your ability to function and maintain work skills.

Inflammatory arthritis is a disability often causing inflammation – and distinct pain, in joints.  It frequently is associated with swelling and tenderness.  It is associated with disorders such as Rheumatoid arthritis, Sjogren’s syndrome, Psoriatic arthritis, gout and psuedo-gout, lyme disease, and inflammatory bowel syndrome. The pain and other symptoms may result in difficulty with many forms of movement, and may effect one’s ability to work.

The Social Security Administration (SSA) evaluates inflammatory arthritis under listing 14.09 of the Impairment Listing Manual.  The regulation references persistent inflammation or persistent deformity of …weight-bearing joints resulting in the inability to ambulate effectively or … the inability to perform fine and gross movements effectively or inflammation or deformity in one or more major peripheral joints with involvement of two or more organs/body systems with one of the organs/body systems involved at least to a moderate level of severity; and at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) or … ankylosing spondylitis or other spondyloarthropathies, or … repeated manifestations of inflammatory arthritis, with at least two of the constitutional symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and one of the following at the marked level: Limitation of activities of daily living, limitation in maintaining social functioning, limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace. You can view that listing at:   https://www.ssa.gov/disability/professionals/bluebook/14.00-Immune-Adult.htm#14_09

There are severity requirements outlined in this listing, but even if not met, it is still possible that you may be entitled to disability benefits dependent upon your ability to function and maintain work skills.

As with most all claims, it is vitally important to get appropriate medical treatment.  Without these medical records, your case is typically much less convincing.  While medical services and insurance is not always available, urgent situations should result in hospital ER treatment in order to show the reality of your symptoms.

If you have Degenerative Disk Disease and are unable to work as a result of your diagnosis, you may be entitled to Social Security Disability benefits. The Social Security Administration (SSA) classifies Degenerative Disk Disease as a disorder of the spine under Listing 1.04 of the Impairment Listing Manual.

When filing a claim for disability benefits with a diagnosis of Degenerative Disk Disease, it is important to have medical records showing evidence of the following criteria, set forth in Listing 1.04:

1. Nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine); OR

2. Spinal arachnoiditis, confirmed by an operative note or pathology report of tissue biopsy, or by appropriate medically acceptable imaging, manifested by severe burning or painful dysesthesia, resulting in the need for changes in position or posture more than once every 2 hours; OR

3. Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively.

Many people don’t have an exact fit to the SSA’s criteria for DDD as listed in the regulation.  Under those circumstances, SSA will evaluate your Residual Functional Capacity, assessing the degree to which your functioning is limited by your impairments.  This RFC assessment may also be applicable with a combination of diseases.

Our law office frequently deals with cases involving Degenerative Disk Disease, or DDD and combinations of other disabilities.  Seeking the services of an experienced Social Security Disability attorney to help obtain and present evidence to SSA about your condition can be vital to your claim for benefits. Feel free to call should you have any questions.

No doubt that receiving a diagnosis of cancer is both traumatic and overwhelming. You may be unable to work and keep up with their normal everyday lifestyles as a result. Depending on the nature of the cancer, you may be eligible to qualify them to receive Social Security Disability Insurance benefits (SSDI) or Supplemental Security Income benefits (SSI).

Certain cancers make an applicant immediately eligible to start receiving benefits. Based on the cancer diagnosis alone, the following types of cancers garner immediate approval: metastatic brain or spinal cord carcinoma, inflammatory breast cancer, mesothelioma of the pleura, small cell cancer of the lungs, primary cancer of bile ducts, liver, or gall bladder, and pancreatic cancer.

Further, if the applicant’s cancer has spread beyond the regional lymph nodes it is likely that the applicant will be approved by meeting the neoplastic disease listing. http://www.socialsecurity.gov/disability/professionals/bluebook/13.00-NeoplasticDiseases-Malignant-Adult.htm

The Social Security Administration (SSA) makes a decision based on the applicant’s medical record and documentation to prove hospital admissions and discharges, physician office notes, imaging studies, and blood work. Specifically, SSA looks for the cancer’s origin, whether it is primary, recurrent, or a metastatic malignant tumor.  It may review biopsy operative results as well.

For individuals suffering from a type of cancer that is not listed above, there is still potential for disability benefits. Often, it reduces down to the fact that an individual must prove that their functional capacity is limited, and prevents working, because of the effects of the cancer and treatment. Even those in remission may show SSA that there is significant post-treatment symptoms that still restrict their ability to work.  This analysis is fairly typical in many of the cases we see at Margolius, Margolius and Associates.  It exemplifies those difficult situations where the reality of the disability is not quick to prove, but nevertheless is deserving of approval of benefits.  Feel free to call should you have any questions.

Down syndrome is caused by an individual having an extra chromosome. In the United States, 1 in every 691 babies are born with Down syndrome, making it the most common genetic condition. The genetic condition affects each child’s course of development differently. Some of the most common physical traits are small stature, slanted eyes, and low muscle tone. https://ndss.org/about

If your child has been diagnosed with non-mosaic Down syndrome and meets SSA’s financial requirements, he or she will automatically start receiving SSI payments. You can prove your child’s non-mosaic Down syndrome disability by a laboratory test or by obtaining a report from your child’s physician. The specific laboratory test needed is called a karyotype chromosomal analysis. If the laboratory results are unavailable, you will need to obtain a physician report stating that your child has the chromosome disorder consistent with the karyotype analysis or that the child has Down syndrome with the distinctive facial or other physical features. For a more detailed overview of the needed medical evidence please visit SSA’s website at https://www.ssa.gov/disability/professionals/bluebook/110.00-MultipleBody-Childhood.htm#110_06

Your child may be eligible to receive SSI benefits right away. Generally, the Social Security Administration takes anywhere between three to five months to make a decision on whether your child is disabled and eligible to receive SSI benefits. However, SSA will start making payments right away if you can show that your child is suffering from non-mosaic Down syndrome.

Other conditions that make your child eligible for immediate SSI payments include HIV infection, total blindness, total deafness, cerebral palsy, low birth weight, and severe intellectual disorder. https://www.ssa.gov/pubs/EN-05-10026.pdf

Many people suffer from anxiety, and some have anxiety levels that are disabling.  The Social Security Administration evaluates mental disorders under a specific type of regulation called “12.06.”  To qualify as an anxiety disorder under 12.06, anxiety must be either the predominant disturbance or experienced as a result of an individual’s attempts to master symptoms. In order for an anxiety disorder to be sufficiently severe for the SSA to render a finding of disabled, the requirements in section A and B or in A and C of 12.06 must be satisfied.

There are 5 ways in which an individual can satisfy section A through production of medically documented findings. The first is generalized persistent anxiety accompanied by at least 3 of these 4 symptoms: motor tension, autotomic hyperactivity, apprehensive expectation, or vigilance and scanning. The second is a persistent irrational fear of a specific object, activity, or situation which results in a compelling need to avoid that object, activity, or situation. The third is recurrent severe panic attacks occurring at least once a week. The fourth is recurring obsessions or compulsions which are a source of marked distress. The fifth is recurrent and intrusive recollections of a traumatic experience, which are a source of marked distress. At least 1 of the foregoing must be shown through medically documented evidence in order to satisfy section A.

In addition to satisfying the section A requirements, an individual must satisfy the requirements in either section B or section C in order for SSA to determine that a condition is sufficiently severe to meet Listing 12.06. Section B requires that an individual show that his or her condition results in at least 2 of the following: a marked restriction of activities of daily living, marked difficulties in maintaining social functioning, marked difficulties in maintaining concentration, persistence or pace, or repeated episodes of decompensation, each of extended duration. “Marked” in this context means more than moderate and less than extreme. If an individual does not meet the requirements of section B, SSA will look to section C. This section requires that an individual show that a disorder results in the complete inability to function independently outside of one’s home.

If your anxiety disorder does not meet or equal the listing of 12.06, it does not necessarily mean you will be found not disabled. You may have a combination of impairments for example.  All disabilities often get evaluated in something called a Residual Functional Capacity.  For more on this, please see other blog entries or call our office.  https://www.ssa.gov/Regardless, getting treatment for any disability,  is not only good for you, but is good evidence for us.  If possible, see someone about your anxiety or other disabilities.