Written By Rick Gach If you're applying for Social Security disability benefits, a recent rule change by the Social Security Administration (SSA) could have a significant impact on your claim. Effective June 8, 2024, the SSA will be making changes to how they evaluate your past work when determining your eligibility for disability benefits. Under the new rule, the SSA will only consider jobs you've held within the past 5 years as relevant to your disability claim. This is a significant reduction from the previous 15-year period. Additionally, any past work that lasted fewer than 30 calendar days will no longer be considered as part of your work history. What does this mean for you? In short, these changes should make the disability application process less burdensome and more focused on your recent work experience. You'll no longer need to struggle to remember details of jobs you held more than 5 years ago, which can often be difficult and lead to errors in your application. By focusing on your more recent work history, the SSA aims to improve the accuracy of the information you provide and potentially speed up the decision-making process. Another positive aspect of this rule change is that the SSA is updating its work history report forms and instructions. The new forms will align with the 5-year relevant work period and exclude jobs lasting under 30 days. This should make completing the paperwork easier and less time-consuming for you. It's important to note that the SSA expects this rule change to result in an increase in disability benefit approvals. While this may lead to higher program costs, the SSA believes that the benefits to claimants like you justify the expense. During the rulemaking process, most commenters supported the proposed changes, recognizing the positive impact they could have on the lives of disability applicants. As you prepare to file your disability claim or if you're in the midst of the application process, be sure to keep this new rule in mind. If you have any questions about how the changes might affect your specific case, don't hesitate to reach out to the SSA or your disability attorney for guidance. Remember, the SSA's goal with this rule change is to make the disability application process more manageable and efficient for you. By reducing the burden of providing extensive work history details and focusing on your more recent and relevant experiences, the SSA hopes to provide better service and support as you navigate your disability claim. If you have any questions about how the new Social Security rule might impact your disability claim or if you need assistance navigating the application process, the experienced attorneys at Hogan Smith SSD are here to help. With a deep understanding of the ever-changing disability claim landscape, we can provide you with the guidance and support you need to maximize your chances of success. Don't let the complexities of the disability claim process overwhelm you. Call Hogan Smith SSD today at 407-377-0700 or visit our website at www.hogansmithssd.com to schedule a consultation with one of our knowledgeable attorneys. Let us put our expertise to work for you and help you secure the disability benefits you deserve. Source: https://www.federalregister.gov/documents/2024/04/18/2024-08150/intermediate-improvement-to-the-disability-adjudication-process-including-how-we-consider-past-work#print

Written by Rick Gach If you or a loved one receives Supplemental Security Income (SSI), a recent policy change from the Social Security Administration (SSA) could significantly impact your monthly benefits. As of September 30, 2024, rental subsidies will no longer count as income when calculating SSI eligibility and payment amounts. This is a substantial shift that could provide a much-needed financial boost for SSI recipients nationwide. What does this mean for SSI beneficiaries? Let's break it down: Currently, if an SSI recipient receives free or reduced rent, such as living with a family member rent-free, the SSA considers this "in-kind support and maintenance" (ISM). The value of this ISM is counted as income, which reduces the individual's SSI payment. For example, if an SSI recipient receives $300 worth of ISM in the form of free rent, their monthly SSI payment would be reduced by $300. Under the new rule, effective September 30, 2024, rental subsidies will no longer be counted as ISM. This means that SSI recipients who receive free or reduced rent will be able to keep their full SSI payment without any reduction. In the example above, the individual would receive their full SSI payment (e.g., $914 in 2023), even while benefiting from the $300 rental subsidy. This policy change is a significant win for SSI beneficiaries. It allows individuals to maintain stable housing situations with support from family or other sources without jeopardizing their SSI benefits. The extra money in their monthly SSI checks can make a real difference in covering essential expenses like food, healthcare, and utilities. Moreover, this change may allow more individuals to qualify for SSI in the first place. By excluding rental subsidies from income calculations, some people who were previously over the income limit may now be eligible for SSI benefits. If you or someone you know receives SSI and benefits from a rental subsidy, it's important to understand how this policy change may impact your situation. As always, our team at Hogan Smith is here to help navigate the complexities of SSI and ensure you receive the maximum benefits you deserve. Contact us today to discuss your case and learn more about how this new rule may apply to you.

Written By Rick Gach The Social Security Administration (SSA) provides financial assistance to millions of Americans through various programs, such as retirement, disability, and supplemental security income (SSI). In some cases, the SSA may require a representative payee to manage the benefits on behalf of the recipient. This blog post will explore the reasons behind this requirement and the rights of beneficiaries in choosing their representative payee. Why Does the SSA Require a Representative Payee? The SSA may determine that a beneficiary needs a representative payee if they believe the individual cannot manage their finances independently. This decision is made to ensure that the benefits are used for the recipient's basic needs and well-being. Some reasons why the SSA might require a representative payee include: Mental or physical impairments that hinder the ability to manage finances History of substance abuse or mismanagement of funds Being a minor child receiving benefits The representative payee is responsible for using the benefits to pay for the beneficiary's living expenses, such as food, housing, medical care, and personal needs. They must also keep accurate records of how the funds are spent and report to the SSA when required. Your Rights in Choosing a Representative Payee As a beneficiary, you have the right to participate in selecting your representative payee. The SSA will consider your preferences when appointing a payee, but they must also ensure that the chosen individual is suitable for the role. Here are some key points to keep in mind: You can suggest a preferred representative payee to the SSA, such as a family member, friend, or organization you trust. If you disagree with the SSA's choice of representative payee, you have the right to appeal the decision and present evidence supporting your preferred choice. You can request a change in representative payee if you believe the current payee is not acting in your best interests or mismanaging your benefits. If no suitable family member or friend is available, the SSA may appoint an organizational payee, such as a social service agency or non-profit organization. It is essential to choose a representative payee whom you trust and who will prioritize your well-being. Open communication with your payee is crucial to ensure that your needs are met and that your benefits are being managed appropriately. Conclusion The representative payee system is designed to protect the interests of Social Security beneficiaries who may have difficulty managing their finances. While the SSA makes the final decision on appointing a payee, beneficiaries have the right to participate in the selection process and voice their preferences. By understanding the role of a representative payee and your rights as a beneficiary, you can work towards ensuring that your benefits are managed effectively and in your best interests. SSI - Representative Payee

In a significant move to improve access to critical benefits, the Social Security Administration (SSA) has published a final rule titled "Omitting Food from In-Kind Support and Maintenance (ISM) Calculations." This rule, set to take effect on September 30, 2024, is the first of several updates to the agency's Supplemental Security Income (SSI) regulations aimed at helping people receiving and applying for SSI. The SSI program provides monthly payments to adults and children with disabilities or blindness, as well as adults aged 65 and older, who have limited income and resources. These benefits help cover basic needs such as rent, food, clothing, and medicine. To be eligible for SSI, applicants must meet specific requirements, including income and resource limits. Under the previous rules, ISM included food, shelter, or both that a person receives, and the agency counted ISM as unearned income, potentially affecting a person's eligibility or reducing their payment amount. The new rule removes food from ISM calculations, eliminating a significant barrier for SSI eligibility due to an applicant's or recipient's receipt of informal food assistance from friends, family, and community support networks. This change brings several important benefits: 1. The new policy is easier to understand and use by applicants, recipients, and agency employees. 2. Applicants and recipients will have less information to report about food assistance received from family and friends, reducing a significant source of burden. 3. Reducing month-to-month variability in payment amounts will improve payment accuracy. 4. The agency will see administrative savings because less time will be spent administering food ISM.  As a representative for claimants in their disability claims with the SSA, I welcome this change. The removal of food from ISM calculations will help more individuals access the critical benefits they need to support themselves and their families. By simplifying the application process and reducing the burden on applicants, the SSA is taking a significant step towards promoting equity and removing barriers to accessing payments. The SSA has stated that it will continue to examine programmatic policy and make regulatory and sub-regulatory changes as appropriate. In the coming weeks, we can expect more announcements related to the SSI program, further demonstrating the agency's commitment to improving access to benefits for those who need them most. If you or someone you know is interested in applying for SSI, visit the Social Security Administration's website for more information on eligibility and how to apply. As always, if you need assistance with your disability claim, do not hesitate to reach out to a qualified representative who can guide you through the process and help ensure you receive the benefits you deserve.

If you're in the process of applying for Social Security Disability benefits, you may be asked to have a friend, family member, or caregiver complete a Third Party Function Report. This form, also known as the SSA-3380-BK, is designed to provide the Social Security Administration (SSA) with valuable insights into your daily activities, limitations, and overall functioning. In this blog post, we'll walk you through the key steps and tips for completing this important form. 1. Choose the right person: Select someone who knows you well and has regular interaction with you, such as a close family member, friend, or caregiver. This person should be able to provide accurate and detailed information about your daily activities and limitations. 2. Provide specific examples: When describing your limitations, it's essential to be as specific as possible. Instead of simply stating that you have difficulty walking, provide concrete examples, such as "I can only walk for 10 minutes before needing to rest due to severe back pain." The more detailed the examples, the better the SSA can understand your situation. 3. Be honest and comprehensive: It's crucial to provide an honest and complete picture of your daily challenges. Don't downplay or exaggerate your limitations. Be sure to include information about any assistance you require or adaptive devices you use to complete daily tasks. 4. Discuss the impact on daily activities: Focus on how your impairments affect your ability to perform everyday tasks, such as personal care, household chores, and social interactions. Provide examples of activities you struggle with or can no longer do because of your condition. 5. Address good days and bad days: Many people with disabilities experience fluctuations in their symptoms. It's important to discuss how your condition varies on good days versus bad days, and how often you experience each type of day. 6. Collaborate with the person completing the form: Work closely with the person filling out the Third Party Function Report on your behalf. Schedule a meeting or phone call to discuss your daily experiences, challenges, and limitations in detail. This collaboration will help ensure that the information provided is accurate and comprehensive. 7. Review the completed form: Before the Third Party Function Report is submitted, take the time to review the form for any errors, inconsistencies, or omissions. If necessary, provide additional information or clarification to ensure that the SSA has a clear understanding of your situation. Remember, the Third Party Function Report is an opportunity for the SSA to gain a better understanding of how your impairments affect your daily life. By following these tips and providing detailed, accurate information, you can increase your chances of a successful disability claim. If you have any questions or concerns about the Third Party Function Report, don't hesitate to reach out to your disability attorney or advocate for guidance.

Medicare is a health insurance plan for people who are age 65 or older. People who are disabled or have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease) can get Medicare at any age. Medicare has four parts: Hospital insurance (Part A) helps pay for inpatient hospital care and certain follow-up services. Medical insurance (Part B) helps pay for doctors’ services, outpatient hospital care and other medical services. Medicare Advantage plans (Part C) are available in many areas. People with Medicare Parts A and B can choose to receive all of their health care services through a provider organization under Part C. Prescription drug coverage (Part D) helps pay for medications doctors prescribe for medical treatment. Who is eligible for hospital insurance (Part A)? Most people get hospital insurance when they turn 65. You qualify for it automatically if you are eligible for Social Security or Railroad Retirement benefits. Or you may qualify based on a spouse’s (including divorced spouse’s) work. Others qualify because they are government employees not covered by Social Security who paid the Medicare tax. If you get Social Security disability benefits for 24 months, you will qualify for hospital insurance. If you get disability benefits because you have amyotrophic lateral sclerosis (Lou Gehrig’s disease), you do not have to wait 24 months to qualify. Also, people who have permanent kidney failure that requires maintenance dialysis or a kidney replacement qualify for hospital insurance if they have worked long enough or if they are the spouse or child of a person who has worked long enough. Who can get medical insurance (Part B)? Almost anyone who is eligible for hospital insurance can sign up for medical insurance. Part B is an optional program. It is not free. In 2008, the standard monthly premium is $96.40. Some people with higher incomes will pay higher premiums. Who can get Medicare Advantage plans (Part C)? Anyone who has Medicare hospital insurance (Part A) and medical insurance (Part B) can join a Medicare Advantage plan. Medicare Advantage plans include: Medicare managed care plans; Medicare preferred provider organization (PPO) plans; Medicare private fee-for-service plans; and Medicare specialty plans. You might have to pay a monthly premium because of the extra benefits the Medicare Advantage plan offers. Who can get Medicare prescription drug coverage (Part D)? Anyone who has Medicare hospital insurance (Part A) or medical insurance (Part B) or a Medicare Advantage plan (Part C) is eligible for prescription drug coverage (Part D). Prescription insurance is optional, and you pay an additional monthly premium for the coverage. For more information, contact SSA and ask for Medicare (Publication No. 05-10043). Help with Medicare expenses for people with low income. If you have a low income and few resources, your state may pay your Medicare premiums and, in some cases, other “out-of-pocket” medical expenses, such as deductibles and coinsurance. Only your state can decide whether you qualify for help under this program. If you think you qualify, contact your state or local medical assistance (Medicaid) agency, social services or welfare office. You can get more information about this program from the publication, If you need help paying Medicare costs, there are programs that can help you save money (Publication CMS-10126). To get a copy, call the Medicare toll-free number, 1-800-MEDICARE (1-800-633-4227). If you are deaf or hard of hearing, you may call TTY 1-877-486-2048. “Extra help” with Medicare prescription costs : If you have limited income and resources, you may qualify for extra help to pay for your prescription drugs under Medicare Part D. Social Security’s role is to help you understand how you may qualify and to process your application for extra help. To see if you qualify or to apply, call Social Security’s toll-free number or visit our website.

During a trial work period, a beneficiary receiving Social Security disability benefits may test his or her ability to work and still be considered disabled. We do not consider services performed during the trial work period as showing that the disability has ended until services have been performed in at least 9 months (not necessarily consecutive) in a rolling 60-month period. In 2007, any month in which earnings exceed $640 is considered a month of services for an individual's trial work period. In 2008, this monthly amount increases to $670. Monthly earnings that trigger a trial work period Year Monthly earnings: 1978 & prior $50 1979-1989 75 1990-2000 200 2001 530 2002 560 2003 570 2004 580 2005 590 2006 620 2007 640 2008 670

THE SAVAGE TRUTH | Enrollment time is here again -- follow these steps to choose what works best November 17, 2008 TERRY SAVAGE savage@suntimes.com Here we go again. Starting today, seniors have six weeks to sign up for another year of Medicare Part D -- the prescription drug benefit -- that goes along with Medicare Part A (hospitalization), Part B (outpatient and doctor costs) and Medigap (the supplement that covers other costs including co-payments and deductibles). It's a must-do project, even if you're among the few seniors who don't currently take prescription drugs. If you don't sign up when you first become eligible, there will be big penalties to pay once you do need some prescriptions -- and for sure you will need them at some point. The Medicare.gov Web site sorts through all of the alternative plans to find you the best coverage at the least cost in a plan that is available at a pharmacy near you. The only exceptions are those seniors who are covered by a comparable company or retiree prescription plan, or those who have signed up for an all-in-one Medicare Advantage plan. Some seniors have prescription drug access through the Veterans Administration, though they may want to choose an inexpensive Part D plan for drugs the VA does not cover. For those who recently turned 65 and now qualify for Medicare, this will be the first time going through the process of choosing the least-expensive plan. But every senior, even those currently enrolled and happy with their drug plan, should go through the process of reviewing the alternatives for 2009. That's because each year, the plans change the prices of the drugs they cover and may not even include the same medicines in the year ahead. So here's my annual, step-by-step guide through the Medicare.gov Web site, the only place that can sort through all of the alternative plans to find you the best coverage at the least cost in a plan that is available at a pharmacy near you! Finding your plan at Medicare.gov Step 1. Get a complete list of all of the medicines and dosages you are now taking. The easiest way is to ask your pharmacist for this list, or simply line up all of your prescription bottles. Step 2. Go to www.Medicare.gov. (If you don't have a computer, you can call 800-MEDICARE, and they will help you through this process over the telephone.) Step 3. Click on the line near the top of the first page screen that says: "Medicare Prescription Drug Plans -- 2009 Plan Data." Step 4. On the next page, click on the box that says "Find and Compare Plans." Step 5. On the next page, you have a choice of either a "personalized" search or a "generalized" search. If you already have your red, white, and blue Medicare card, you can use the personalized search, in which you input your Medicare number and other information from your card. (You can use the generalized search to find and compare plans in your ZIP code.) Step 6. On the next page, you can enter the drugs you are currently taking, and the dosages. Even if you do not take prescription drugs now, you must fill out this page, stating that fact. This list can be saved securely for your future visits to Medicare.gov. You can either type in the names of your drugs, or search for them alphabetically. The most common dosage will automatically pop up, but you should be sure that is the dosage you are taking. The program will also let you know if there is a less-expensive generic available. When you've finished listing your prescriptions, click "continue" to move on to the next page where you can recheck the list of names and dosages. Then click "continue" again. Step 7. You'll be asked if you have a specific pharmacy that you'd like to work with -- one that's within walking distance of your home, for example. Then click again. Step 8. You've finally arrived at the most important page -- the one that lists all of the plans, ranked with the lowest total cost at the top of the list. You can select up to three plans to compare. You can click to see how you might lower your cost, perhaps by switching to a generic. Or the program might suggest an alternative but less-expensive drug in the same category. That's something you'd have to discuss with your physician. This year, there are also "star" ratings, up to five stars, based on a survey done for Medicare about the quality and performance of those plans over the last year. Step 9. After comparing the plans by cost, click on the name of each plan provider to find full details, including a helpful graph of the average monthly cost, as well as information about participating pharmacies and mail order availability. You can print out the pages for each plan, and keep them handy. Step 10. Before signing up, call the plan's toll-free number and reconfirm their prices and coverages for the drugs you take, as well as all co-payments. Then you're ready to ask them to send you the application so you can sign up! A plea for help: Government should be required to make these decisions easier for seniors. But since it hasn't, I'm asking the more computer-literate among you to clip this column, find a senior, and offer to help. It's easy once you've done it. And that's The Savage Truth. Terry Savage is a registered investment adviser. Distributed by Creators Syndicate. Copyright Terry Savage Productions Ltd. Visit www.terrysavage.com and suntimes.com.

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Compassionate allowances are a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Compassionate allowances will allow Social Security to quickly target the most obviously disabled individuals for allowances based on objective medical information that we can obtain quickly. List of Conditions: 1 Acute Leukemia 2 Adrenal Cancer - with distant metastases or inoperable, unresectable or recurrent 3 Alexander Disease (ALX) - Neonatal and Infantile 4 Amyotrophic Lateral Sclerosis (ALS) 5 Anaplastic Adrenal Cancer - with distant metastases or inoperable, unresectable or recurrent 6 Astrocytoma - Grade III and IV 7 Bladder Cancer - with distant metastases or inoperable or unresectable 8 Bone Cancer - with distant metastases or inoperable or unresectable 9 Breast Cancer - with distant metastases or inoperable or unresectable 10 Canavan Disease (CD) 11 Cerebro Oculo Facio Skeletal (COFS) Syndrome 12 Chronic Myelogenous Leukemia (CML) - Blast Phase 13 Creutzfeldt-Jakob Disease (CJD) - Adult 14 Ependymoblastoma (Child Brain Tumor) 15 Esophageal Cancer 16 Farber's Disease (FD) - Infantile 17 Friedreichs Ataxia (FRDA) 18 Frontotemporal Dementia (FTD), Picks Disease -Type A - Adult 19 Gallbladder Cancer 20 Gaucher Disease (GD) - Type 2 21 Glioblastoma Multiforme (Brain Tumor) 22 Head and Neck Cancers - with distant metastasis or inoperable or uresectable 23 Infantile Neuroaxonal Dystrophy (INAD) 24 Inflammatory Breast Cancer (IBC) 25 Kidney Cancer - inoperable or unresectable 26 Krabbe Disease (KD) - Infantile 27 Large Intestine Cancer - with distant metastasis or inoperable, unresectable or recurrent 28 Lesch-Nyhan Syndrome (LNS) 29 Liver Cancer 30 Mantle Cell Lymphoma (MCL) 31 Metachromatic Leukodystrophy (MLD) - Late Infantile 32 Niemann-Pick Disease (NPD) - Type A 33 Non-Small Cell Lung Cancer - with metastases to or beyond the hilar nodes or inoperable, unresectable or recurrent 34 Ornithine Transcarbamylase (OTC) Deficiency 35 Osteogenesis Imperfecta (OI) - Type II 36 Ovarian Cancer - with distant metastases or inoperable or unresectable 37 Pancreatic Cancer 38 Peritoneal Mesothelioma 39 Pleural Mesothelioma 40 Pompe Disease - Infantile 41 Rett (RTT) Syndrome 42 Salivary Tumors 43 Sandhoff Disease 44 Small Cell Cancer (of the Large Intestine, Ovary, Prostate, or Uterus) 45 Small Cell Lung Cancer 46 Small Intestine Cancer - with distant metastases or inoperable, unresectable or recurrent 47 Spinal Muscular Atrophy (SMA) - Types 0 And 1 48 Stomach Cancer - with distant metastases or inoperable, unresectable or recurrent 49 Thyroid Cancer 50 Ureter Cancer - with distant metastases or inoperable, unresectable or recurrent 

To encourage disabled individuals to attempt to work, Congress enacted section 303 of the 1980 amendments that provided a re-entitlement period under title II to an individual who completes 9 months of trial work and continues to have a disabling impairment. This provision, referred to as the extended period of eligibility (EPE), provides that an individual can be re-entitled to benefits any time during the re-entitlement period that his or her work activity falls below the SGA level. The EPE re-entitlement period begins with the month immediately following completion of the trial work period and ends 36 months later (or 15 months later if the beneficiary is not entitled to benefits after 12/1987). However, if the beneficiary is not engaging in SGA when the re-entitlement period ends, the EPE provision allows benefits to continue until SGA is performed (or medical cessation is determined). When an SGA disability cessation determination is made within the EPE, the termination month is the first month of substantial gainful activity (SGA) after the 36-month re-entitlement period ends. When a disability cessation has not already been determined, the termination month is the third month after the first month of SGA after the 36-month period. If an individual's payments stop because disability has ceased due to work activity and, subsequently, but within the EPE re-entitlement period, his/her earnings fall below SGA, benefits may be reinstated if all other entitlement factors are met. A new application, and disability determination, is not required to reinstate payments in these cases. The extended period of eligibility does not change the definition of disability. A beneficiary is eligible for payments as long as he/ she continues to meet the definition of disability. The EPE does not limit the payment of disability benefits after disability ceases; e.g., an individual whose disability ceases is eligible for title II payments for the month of cessation and 2 additional months. The main effect of the EPE provision is that it permits benefit reinstatement during the re-entitlement period when a beneficiary's benefits have stopped because of SGA and the beneficiary's earnings subsequently fall below SGA levels (see DI 13010.215 B).

If you are the unmarried child under 18 (up to age 19 if attending elementary or secondary school full time) of a worker who dies, you also can be eligible to receive Social Security survivor benefits. Your survivor benefit amount would be based on the earnings of the person who died. The more he or she paid into Social Security, the higher your benefits would be. The amount you would get is a percentage of the deceased's basic Social Security benefit and depends on your age and the type of benefit you would be eligible to receive. A child under age 18 (19 if still in elementary or secondary school) or disabled is entitled to receive 75 percent of the deceased monthly social security benefit. There is a maximum benefit per month that can be paid to all the survivors on the record. There may also be a special lump-sum death benefit. The limit varies, but it is generally equal to about 150 to 180 percent of the basic benefit rate. For more information about Survivor Benefits for Children, click on the email link above.

Social Security uses a 5 step sequential evaluation process to determine if you are disabled. The first step is to determine whether you have SGA. If you are working and earning above a certain level, the Social Security Administration (SSA) will deny your claim. However, if your earnings fall below a certain level you may still be entitled to disability and SSA will move on to step two of the evaluation process. The chart below shows the amounts that SSA uses to determine SGA:

You probably know people who are receiving Social Security survivors benefits because they're a widow or widower. At present, there are about 5 million widows and widowers receiving monthly Social Security benefits based on their deceased spouse's earnings record. And, for many of those survivors, particularly aged women, those benefits are keeping them out of poverty. Your widow or widower can receive - reduced benefits as early as age 60 or full benefits at full retirement age or older. - benefits as early as age 50 if he or she is disabled . Note : If your widow or widower remarries after age 60 (age 50 if disabled), he or she will still be eligible for benefits on your record. Your widow or widower who has not remarried can receive survivors benefits at any age if she or he takes care of your child who is under age 16 or is disabled and receives benefits on your record. If something happens to you, benefits may be payable to your widow or widower with a disability if the following conditions are met: He or she is between ages 50 and 60. The widow or widower meets the definition of disability for adults. The disability started before your death or within seven years after your death. Note : If your widow or widower caring for your children receives Social Security benefits, he or she is eligible if disability starts before those payments end or within seven years after they end. 

By Sam McManis smcmanis@sacbee.com Published: Sunday, May. 31, 2009 - 12:00 am | Page 2I Asked to describe the seemingly indescribable, to make real the manifestations of a medical condition that some still doubt even exists, fibromyalgia patients often rely on similes of the most wince-inducing sort. • "I felt like acid was going through my veins." • "It was like a steamroller ran over me." • "Fatigue like someone's pulled out your battery pack." • "… as if someone pinged me with a hammer all over my body." • "Your (brain) feels like a pinball machine. You're trying to come up with the word, and the ball bounces around until it finally falls on your tongue." • "It feels like death, only worse." Can there be any doubt that these people truly are suffering from diffuse, widespread chronic pain with multiple tender spots, enervating fatigue and a host of symptoms that include restless legs, impaired memory and depression? Well, yes. Despite being recognized as a diagnosable disease by the American College of Rheumatology, the Food and Drug Administration and most insurers, fibromyalgia has not completely shed the stigma of being dismissed as "psychosomatic" by some in the medical establishment. Controversy swirls even as new FDA-approved medications have shown promise and recent brain imaging research has shown central nervous system changes in those afflicted. The National Fibromyalgia Association, a patient advocacy group, estimates that 10 million Americans suffer from one or more of the multifarious manifestations of the condition. It is this array of symptoms not linked to specific cause and effect – as opposed to how rheumatoid arthritis can ravage a patient's joints – that keeps skeptics in mainstream medicine from validating fibromyalgia as a legitimate disease. Where, exactly, is this deep muscular aching? What's the cause of that nebulous numbness and dizziness? Why won't painkillers help? Where are the lab tests that can prove it exists? Those are the questions that still dog fibromyalgia patients. "They make you think you're a hypochondriac or something," says Jennifer Filbeck, 36, a former restaurant manager from Fairfield who's been unable to work since 2006. "Doctors treat you like you're crazy." Not crazy per se, critics of the existence of fibromyalgia claim. Their argument: These people suffer from psychological conditions that manifest themselves in vague and hard-to-define physical maladies. Dr. Frederick Wolfe, who wrote the landmark 1990 paper that first created diagnostic guidelines for fibromyalgia, recently told the New York Times that he now considers it merely a byproduct of depression, stress and social anxiety. Wolfe, head of the National Databank of Rheumatic Diseases, told the paper, "Some of us in those days thought that we had actually identified a disease, which clearly this is not. To make people ill, to give them an illness, was the wrong thing." That view is supported by Dr. Nortin Hadler, a rheumatologist and professor at the University of North Carolina. Writing in the Journal of Rheumatology, Hadler states bluntly that fibromyalgia is all in the mind. "I am suggesting that chronic persistent pain is an ideation, a somatization if you will, that some are inclined toward as a response to living life under a pall, and not vice versa," he writes. "I am further suggesting that these people choose to be patients because they have exhausted their wherewithal to cope." Medical literature has been slow to publish data on fibromyalgia. Recent studies have gone a long way in disputing the claims of Wolfe and Hadler, though researchers still have yet to pinpoint a cause. A 2008 University of Michigan study showed that fibromyalgia patients exhibited central nervous system abnormalities that resulted in elevated sensitivity to pain and stimuli. The study, however, tested only 31 subjects. Other research using functional MRI brain scans show increased activity in pain receptors for even minor discomfort among fibromyalgia patients. 

Question: Does Social Security pay you if you become disabled?  Answer: Sometimes. But they aren't afraid to say no. According to a 2004 General Accounting Office, Social Security Administration report, 60 percent of all first initial claims for Social Security disability benefits were rejected. Your most valuable asset is your human capital — your ability to create value in the marketplace and, thereby, earn an income. Yet most people who wouldn't think of leaving their home or auto uninsured (what if there was a fire?) leave their most valuable asset completely unprotected against loss. If you earn $50,000 a year and have 30 years to go in your working life, you stand to earn $1.5 million over that period of time. Let's assume you get a raise or two along the way (averaging 3 percent per year), you would earn about $2.5 million over that period. If you owned a $2.5 million house, would you sleep well at night knowing that a fire might send your wealth up in smoke? Life insurance is pretty straightforward — you're either dead or you're not. Disability insurance isn't quite so simple. For example, what does it mean to be disabled? According to Social Security, you are "disabled" when you have a medical problem that will either kill you or keep you out of work for a year. Also, you must be unable to engage in any "substantial gainful activity." And you get no benefits for short-term or partial disability. And benefits are very limited. That's a pretty narrow definition that leaves a lot of folks out. It would be like buying a homeowners insurance policy that says the house has to completely burn to the ground before your claim gets accepted, and what you get is only enough to rebuild a much smaller house. Clearly, Social Security disability coverage is meant only as a social safety net. A middle class or higher wage earner counting on Social Security to preserve their financial life in the event of a disability is likely to be very disappointed. Speak to your agent about individual, private disability insurance. Ask him about a policy with a definition of disability that takes into account your education, training and experience. You may even be able to get a policy that defines disability in terms of your specific occupation (often referred to as "Own Occ" coverage). Inquire about coverage that pays you even if you are not totally disabled. Why have an incentive not to return to work? That could be the effect of a total-disability-or-nothing policy. Because the cost of living is unlikely to stay level, your benefits should also be able to rise with inflation. Ask about any cost-of-living-adjustment (COLA) features that may be available in any disability income insurance policy you are considering. When will you benefits start? And how long do you want your benefits to last? A month? A year? Until you retire? If you became disabled, your ability to save and invest for a future retirement would be severely compromised. You may wish to consider coverage that pays benefits for life. Nobody wants to think about being disabled. But it can happen to anyone. If you become disabled, Social Security may or may not pay you a benefit — it will depend on a lot of circumstance. Individual disability insurance can make sure that if a disability means you are out of work, it doesn't also mean you're out of luck.

Samuel O. Okpaku MD, PhD Nashville, Tenn. Dr Okpaku is clinical professor of psychiatry at the Vanderbilt University School of Medicine and executive director of the Center for Health Culture and Society in Nashville, Tenn. The author reports no conflicts on interest concerning the subject matter of this article. Acknowledgment—The author is grateful for the helpful assistance of Tamara Smith and staff, Betty Hood, Ann Benes, Dr Tommie Slayden, Jeffrey Eddie, and the staff at the Tennessee DDS. The epidemiology and management of psychiatric disability have gained increased attention for a variety of reasons in the past 3 decades. There are issues of empowerment, advocacy, and reduction of stigma. There are also concerns about cost containment as well as reliability, validity, and efficacy of the determination process. About 20% of adults who receive Social Security disability benefits have psychiatric disability. Psychiatric disability accounts for a significant proportion of private long-term disability claims and payments.1,2 Advances in technology that have had an impact on physical disabilities have not had a corresponding effect on psychiatric disability. This article is based on the United States Social Security Administration (SSA) model of disability assessments for psychiatric impairment. Since its inception in 1935, there have been several amendments and rulings that have attempted to expand and refine the Disability Act. Despite these efforts, the reliability and validity of the disability determination process have been impaired by several factors: • The inherent difficulty of objectifying psychiatric signs and symptoms • The fluctuating nature of psychiatric disorders • Problems with language and communication (central to the collection of data from patients), which may be compromised by the disease process In addition, many individuals who apply for disability on the basis of physical illness also have comorbid mental disorders. Hence, psychiatrists may be called on as treating physicians, consultative examiners, and expert witnesses to provide disability reports. Defining disability The SSA defines disability as “the inability to engage in any substantial gainful activity by reason of medically determinable physical or mental impairments which can be expected to result in death or which has lasted, or can be expected to last, for a continuous period of not less than 12 months.”3 SSA disability is regarded as permanent, although the disability is subject to periodic review. Keep in mind that diagnosis of a mental illness is not necessarily equivalent to disability or functional impairment. An individual who has major depressive disorder is not legally disabled if he or she can engage in “substantive gainful activity.” Substantive gainful activity refers to a level of activity that SSA uses to establish disability. As a rule of thumb, a disabled individual should not be able to participate actively in the national economy. For example, if an attorney has a mental disorder (and therefore cannot effectively practice law) but he can work as a waiter, he is then not legally disabled according to the SSA. In assessing disability, psychiatrists should be aware of opportunities for vocational rehabilitation and work incentives as well as treatment opportunities. The application process The application for Social Security disability benefits is initiated by a claimant who completes a form at the local SSA field office, or by mail or telephone.3 The information obtained at the field office includes background and demographics, such as age, marital status, employment, Social Security coverage, and contact information. Information on the nature of the impairment(s) and other pertinent information relative to the potential disability are obtained. If the claimant’s information passes the initial disability requirements, his file is transmitted to a Disability Determination Service (DDS) team that consists of a disability analyst and a psychiatrist or psychologist. The analyst gets as much information as possible from treating physicians, hospitals, clinics, and other relevant sources. Once the analyst has gathered relevant information to complete the medical evidence, the file is passed on to the DDS psychiatrist or psychologist who reviews the documentation and adjudges whether the patient’s condition: • Meets or equals the (listed) criteria of mental impairments • Does not meet the listed criteria • Falls between meeting and not meeting the criteria For patients who fall within the third category, the psychiatrist or psychologist completes a Residual Functioning Capacity (RFC) form. At this time, a consultation with a vocational analyst may be requested. The disability analyst then makes a determination as to the legal eligibility of the claimant and a decision is made to approve or deny the claim. The appeal process There are 4 steps in the appeal process. If the claim is denied, the claimant can apply for reconsideration. It is important for the claimant to ensure that all relevant information from doctors, hospitals, clinics, and other treatment sources are submitted to the DDS. For the reconsideration process, the case is assigned to a different DDS team. If this reconsideration fails, the claimant can appeal to the next level, which is a hearing before an administrative judge. At this appeal level, the claimant may be represented by an attorney; witnesses and new evidence may be presented, and the claimant may appear in person. The next level for appeal is the SSA appeals court in Baltimore; ultimately, the appeal may be made to a federal court. The medical evidence Generally, individual psychiatrists may contract with their local DDS to provide consultative examinations. There are some key issues in conducting a consultative examination and completing the report. The claimants can request to have the consultative examination carried out by their own treating psychiatrists.3 The psychiatrist should be familiar with the Psychiatric Review Technique form and the Residual Functioning Capacity form used by the DDS.4,5 All available records should be reviewed before the examination to ascertain the specific reasons for the consultative examination. The psychiatrist should specify his role in conducting the examination to dispel the myth that approval for disability is given by the physician. The provision of adequate and comprehensive information that enables the DDS team to make a reasonable, prompt, and fair determination is a sine qua non and is dependent on the accuracy and completeness of patient records. The SSA uses “listings” to approve or deny applications for disability. There are 9 categories under the mental disorder listings used in making such decisions. Each category refers to a disease process or disorder. Using the model of disease → impairment → disability, impairment refers to the signs and symptoms of the disorder that provides medical determination of the condition (criteria A). Disability refers to the severity of restrictions and limitations of functioning (criteria B) that are directly related to criteria A. The 9 diagnostic categories for mental impairments are: • Organic mental disorders • Schizophrenic, paranoid, and other psychotic disorders • Affective disorders • Mental retardation • Anxiety-related disorders • Somatoform disorders • Personality disorders • Substance disorders • Autistic and other pervasive developmental disorders Each listing is further qualified by criteria A and B. For organic mental disorders, schizophrenic, paranoia, and affective disorders, or other psychotic and anxiety-related disorders, an additional set of criteria (criteria C) may be used to meet the diagnostic and impairment-related restriction of functioning requirements. Disability is therefore met when criteria A and B are met, or when criteria C is met. The report should be typewritten (not handwritten). DDS jurisdictions usually provide dictations by phone. Again, the report should provide a longitudinal and current assessment of the case. The pathogenesis of the disease is helpful in establishing the nature and duration of illness. General observations of the patient, his history, and any additional information required for that listing of diagnoses are other essential elements of the report. If there is a comorbidity, this should be stated. This is especially important for the claimant who has several minor disabilities which, when taken together, may affect his ability to work. In addition, for consultative examinations, the number of appointments the patient has canceled and difficulties in keeping appointments may point to a diagnosis of an anxiety-related condition. Prolonged treatment by a primary care physician may be a clue to chronic treatment-resistant depression. The report must record the patient’s education or employment and rehabilitation history. In preparing the report, the psychiatrist should be aware of how, in which manner, and to what extent the mental impairment limits the patient’s functionality.6 Items from criteria A are delusions/hallucinations, catatonic behavior, and incoherence. For criteria B, items are selected from 4 domains: • Activities of daily living (eg, grocery shopping, doing laundry) • Social functioning (eg, ability to interact socially with other people at home or in a public setting) • Concentration, persistence, and pace (eg, inability to complete a task in the given time) • Deterioration or decompensation in work or work like setting (eg, panic attacks, psychotic decompensations, and crying) For these domains, the documentation must be sufficiently descriptive and explicit to permit an assessment of the appropriateness, independence, sustainability, quality, and effectiveness of these functions over long periods. The examples of deficits in those domains must be tied directly to the mental disorder, rather than to circumstantial factors. For example, a statement that “the patient does not do any grocery shopping, laundry, or cooking” or a statement that the patient cannot complete a task will be inadequate without specifically saying that these examples are caused by the clinical manifestations of the mental disorder and not by circumstantial factors. CASE VIGNETTE Tony is 32 years old. He has been ill since age 22, when he was a second-year law student. He came home and informed his parents that poisonous gases were being pumped into his room. He dropped out of school and made attempts to return to school but failed. He has remained paranoid; he keeps to himself and has been hospitalized 5 times. He was hospitalized 6 months ago when he became belligerent at work. He believed his supervisors were out to get him. He has been on a combination of several antipsychotics to help reduce his hallucinations and delusions. His longest period of employment in 10 years was 3 months. He has never earned more than $300 per month. By meeting 1 item from criteria A and 2 items from criteria B, Tony meets (at least superficially) the requirement for disability under the listing of schizophrenia. Alternatively, criteria C may be used. The psychiatric report to DDS should include the date, time, and place of the assessment. It should conclude with a 5-axis diagnosis as well as a statement of daily activities. The report should not make any recommendation as to whether the application should be approved or denied. This is a function for DDS. The report should be signed and dated. DDS evaluation forms The use of and familiarity with the Psychiatric Review Technique form and the Residual Functioning Capacity form can greatly enhance the quality of the medical evidence. The concepts and terms in these forms are those generally used by DDS and administrative judges. Attorneys who represent mentally ill claimants frequently attempt to bolster their cases by having the treating psychiatrist complete these forms. The emphasis in completing these forms is to continuously link the signs, symptoms, and diagnosis to the restrictions and limitations of functioning. The Psychiatric Review Technique form is completed by a DDS psychologist or psychiatrist for all claims that involve mental illness. That form should include a summary of what mental impairments are present and the degree of functional loss in criteria B and C. In activities of daily living and social functioning the functional loss ratings are none, slight, moderate, marked, extreme restrictions, and insufficient evidence. In the domains of deficiencies and concentration, persistence, or pace, the ratings are never, seldom, often, frequent, and constant. For episodes of deterioration or decompensation in work or work like settings, the ratings range from never, or once or twice, to repeated (3 or more times), and continual. The emphasis is on how specific symptoms and signs from the Psychiatric Review Technique Form impair work-related activities in the Residual Functioning Capacity assessment. When the medical evidence shows that the level of severity of impairment falls between “meets or equals” the listed mental criteria or “does not significantly affect work-related capacities” DDS psychiatrists or psychologists usually complete the residual capacity and assessment form. This procedure attempts to gauge what the claimant may do despite his limitations. It assesses the claimant’s impairment, related functioning limitations, the degree, severity, and frequency of the limitations, as well as the claimant’s ability to sustain work-related activities in the face of restricted functioning during a normal work day or week. The form contains examples of mental activities that are grouped under 4 headings: • Understanding, comprehension, and memory (eg, ability to remember locations and work like procedures) • Sustaining concentration and persistence, ability to perform activities within a schedule (eg, attendance and punctuality) • Social interaction (eg, ability to sustain socially appropriate behavior and to maintain a reasonable standard of neatness and cleanliness) • Adaptation (eg, ability to respond adequately and appropriately to the work environment) The RFC items are rated as not significantly limited, moderately limited, markedly limited, no evidence of limitation, or not rateable based on available evidence. Special considerations Some patients such as infants, children, and adolescents have special needs. In this setting, only psychiatrists who have clinical experience working with children and adolescents should agree to do consultative examinations for children under the age of 18. The listings for children are similar to those for adults, but they take into consideration age-appropriate and developmental factors, the unique presentation of certain diagnostic categories in this age group, the impact of schooling, and the need for corroborative evidence. School teachers, social workers, and foster care parents may provide information that is essential for making appropriate decisions. Appropriate psychological tests may contribute to a more informative report. In fact, for children, the use of psychological tests may be more critical than for adults. Another class of claimants are those with multiple minor impairments. Each condition with its concomitant restrictions and functions should be well described. Also, the needs of veterans have taken center stage: practitioners should be familiar with the subtleties of posttraumatic stress disorder. References 1. Leo RJ. Social Security disability and the mentally ill: changes in the adjudicatory process and treatment source information requirements. Psychiatr Ann. 2002;32:284-292. 2. MacDonald-Wilson K, Rogers ES, Anthony WA. Unique issues in assessing work function among individuals with psychiatric disabilities. J Occup Rehabil. 2001;11:217-232. 3. Social Security Administration. Disability Evaluation Under Social Security, January 2005. http://www.socialsecurity.gov. Accessed November 25, 2008. 4. Psychiatric Review Technique form. http://www.fedforms.gov/bgfPortal/docDetails.do?dId=13996. Accessed December 8, 2008. 5. The Residual Functioning Capacity form. http://ssaconnect.com/tfiles/SSA-4734-F4.sup.pdf. Accessed December 8, 2008. 6. Okpaku SO. The psychiatrist and the Social Security Disability and Supplemental Security Income programs. Hosp Community Psychiatry. 1988;39:879-881. Evidence-Based References Disability determination for adults with mental disorders: Social Security Administration vs independent judgments. Am J Public Health. 1994;84:1791-1795. Okpaku SO, Anderson KH, Sibulkin AE, et al. The effectiveness of a multidisciplinary case management intervention on the employment of SSDI applicants and beneficiaries. Psychiatr Rehab J. 1997;20(3).

Listing 112.10 Autistic Disorder and Other Pervasive Developmental Disorders: Characterized by qualitative deficits in the development of reciprocal social interaction, in the development of verbal and nonverbal communication skills, and in imaginative activity. Often, there is a markedly restricted repertoire of activities and interests, which frequently are stereotyped and repetitive. The required level of severity for these disorders is met when the requirements in both A and B are satisfied. A. Medically documented findings of the following: 1. For autistic disorder, all of the following: a. Qualitative deficits in the development of reciprocal social interaction; and b. Qualitative deficits in verbal and nonverbal communication and in imaginative activity; and c. Markedly restricted repertoire of activities and interests; OR 2. For other pervasive developmental disorders, both of the following: a. Qualitative deficits in the development of reciprocal social interaction; and b. Qualitative deficits in verbal and nonverbal communication and in imaginative activity; AND B. For older infants and toddlers (age 1 to attainment of age 3), resulting in at least one of the appropriate age-group criteria in paragraph B1 of listing 112.02; or, for children (age 3 to attainment of age 18), resulting in at least two of the appropriate age-group criteria in paragraphs B2 of listing 112.02. 

Autism starts in childhood and abnormalities continue into adulthood. A seamless discussion must include infants and children under this section, although they could be evaluated under listing 112.10. Autism is a brain disorder that typically affects a person’s ability to communicate, form relationships with others, and respond appropriately to the environment. Some people with autism are relatively high-functioning, with speech and intelligence intact. Others are mentally retarded, mute, or have serious language delays. For some, autism makes them seem closed off and shut down; others seem locked into repetitive behaviors and rigid patterns of thinking. Although people with autism do not have exactly the same symptoms and deficits, they tend to share certain social, communication, motor, and sensory problems that affect their behavior in predictable ways. Isolated in worlds of their own, people with autism appear indifferent and remote and are unable to form emotional bonds with others. Although people with this baffling brain disorder can display a wide range of symptoms and disability, many are incapable of understanding other people’s thoughts, feelings, and needs. Often, language and intelligence fail to develop fully, making communication and social relationships difficult. Many people with autism engage in repetitive activities, like rocking or banging their heads, or rigidly following familiar patterns in their everyday routines. Some are painfully sensitive to sound, touch, sight, or smell. Children with autism do not follow the typical patterns of child development. In some children, hints of future problems may be apparent from birth. In most cases, the problems become more noticeable as the child slips farther behind other children the same age. Other children start off well enough. But between 18 and 36 months old, they suddenly reject people, act strangely, and lose language and social skills they had already acquired.