Social Security Disability Archives

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Obesity and SSDI/SSI Benefits

San Diego Social Security Disability Attorneys Comment on Obesity and SSDI/SSI Benefits

The attorneys at San Diego Disability Law Group recently  had a case involving a young claimant who was five  feet six inches tall and weighed over 350 pounds. She had a BMI over 50. In addition, she had  been diagnosed with scoliosis (a sideways curvature of  the spine associated with pain but  not neurological impairment),lumbar spondylosis (stiffening or fixation of the vertebrae) and hypo joint mobility. She had a high school diploma but no work experience. She took daily pain medication but still woke up  several times per night due to the pain. This caused her to be groggy and not mentally focused during the  day.

One of the issues in the claim involved what effect her obesity was having on her underlying orthopaedic  conditions. In order to properly present her claim we had to research to  what extent obesity  is  considered by the Social Security  Administration. According to the Social Security Administration, obesity is a complex, chronic disease characterized by excessive  accumulation of body fat caused by a combination of factors i.e. genetic, environmental and  behavioral. Obesity is a risk factor that  increases an individual’s chances of developing impairments in  most body systems.

The National Institutes of Health established medical criteria for  the diagnosis of obesity. These guidelines classify overweight and  obesity in adults according to Body Mass Index (BMI). BMI is the  ratio of an individual’s weight in kilograms to the square of his or height in meters.  For adults, both men and women, the guidelines describe a BMI of 25-29.9 as overweight and a  BMI of 30.0 or above as obesity. The guidelines further recognize three levels of obesity. Level I includes BMIs of 30.0 – 34.9. Level II includes BMIs of 35.0 – 39.9. Level III, termed extreme obesity includes BMIs greater than 40.

Prior to October 25, 1999, there was an actual SSA listing  for obesity (9.09). The  listing was deleted because the Social Security  Administration believed that the criteria in the listing were not  appropriate indicators of listing-level severity in that they did not represent  a degree of functional limitation that would prevent an individual from engaging in  any gainful activity.

Although the listing was  deleted, the Social Security  Administration still recognizes obesity as a medically determinable impairment. On September 12, 2002 they  issued a Policy Interpretation Ruling (SSR 02-1p) regarding the  evaluation of obesity.

In the  ruling SSA reminds adjudicators that “obesity  is a medically  determinable impairment and that adjudicators should consider its effects when evaluating disability”. The  ruling also reminds adjudicators that the combined effects of obesity  with other impairments can be greater than the effects of each of the  impairments considered separately. They also instructed adjudicators to consider the  effects of obesity when assessing an individual’s residual functional capacity.

The ruling provides that the Social Security Administration will find that “obesity  is a severe impairment when, alone or in combination with another medically determinable physical or mental impairment(s), it significantly limits an individual’s physical or mental ability to do  basic work activities.” They  will also consider the  effects of any symptoms  (i.e. pain or fatigue)that could limit  functioning.

In our case we believe that we were able to show that the claimant’s obesity combined with her underlying orthopaedic conditions significantly limited her physical and mental ability to do  basic work activities.

SDDLG Specializes in Obesity and SSDI/SSI Benefits

The San Diego Social Security Disability Attorneys with  the San Diego Disability  Law Group will help you present the strongest claim possible for Social Security Disability  based  on obesity  and other limiting conditions.

If you or a friend or family member has a Social Security Disability claim or question, contact the Social Security Disability Attorneys at the  San Diego  Disability Law  Group for a free consultation at 619-338-900.

Residual Functional Capacity

Under the Social Security Act, a claimant is considered “disabled” if (1) she is unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment 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 that twelve months…

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SSA and Fibromyalgia

SSA and Fibromyalgia: Is it Difficult to Obtain Social Security Benefits?

SSA and Fibromyalgia is an interesting topic. A recent issue of the NOSSCR (National Organization of Social Security Claimants’ Representatives) Social Security Forum had a interesting article on why claimants with Fibromyalgia and Chronic Fatigue Syndrome(CFS) oftentimes have a difficult time obtaining social security benefits. One reason is  due to the lack of objective medical findings inherent in these conditions. Let’s learn and discuss how a new Social Security Ruling could help overcome this obstacle.

On July 25, 2012 Social Security Ruling (SSR) 12-2p was issued. SSR-12p states that fibromyalgia may  be a “medically determinable impairment” when it is established by appropriate medical evidence and can be the  basis for a finding of disability. Once fibromyalgia is established as a “medically determinable impairment” it will be considered in the sequential evaluation process. Moreover, this is to determine whether the person is disabled. It is still the  claimant’s burden to provide “sufficient objective evidence to support a finding that the person’s impairment limits the person’s functional abilities. Furthermore, it must also  precludes him or her from performing any substantial gainful activity”.

However. in cases involving fibromyalgia and chronic  fatigue syndrome there is an exception. Once fibromyalgia and chronic  fatigue syndrome have been established, SSA will consider all of the  evidence in the case record. Furthermore, SSA will evaluate the intensity and persistence  of the claimant’s pain or other symptoms. Finally, this is to determine the extent to which the symptom’s limit the person’s capacity for work.

In addition to the physicians diagnoses based on objective criteria, Attorneys  with the San Diego  Disability Law Group  make sure that their clients provide  the administrative law judge with as much longitudinal evidence of symptoms and treatment as possible, as well as reports from family and friends of how the claimant’s impairments affect his/her activities of daily living or ability to work.

If you or a family member has  a question regarding Social Security Disability please contact the San Diego Disability Law Group at (619) 338-9000.

For more information regarding Fibromyalgia visit: www.niams.nih.gov/Health_Info/Fibromyalgia; www.mayoclinic.com/health/fibromylagia; or www.rheumatology.org.

Excuses for Late Disability Appeals

All is not necessarily lost if you don’t get your Social Security Disability appeal filed on time. The Social Security Administration (SSA) regulations recognize several excuses as “good cause” for missing the appeal deadline. An experienced San Diego Social Security attorney can help you establish good cause, or, even better, help you meet the time requirement in the first place.

Procedure for Raising Excuse

The first thing you need to do with a late disability appeal is getting it filed. If it has clearly missed the deadline, you’ll need to include a detailed letter telling the SSA exactly why you are filing late.

If the SSA finds that your explanation amounts to “good cause,” it extends the deadline, magically making your late disability appeal a timely appeal.

Who Determines “Good Cause”

The SSA’s lengthy Program Operations Manual System gives the authority to decide if there is “good cause” to the “individual from the component that has the authority to adjudicate the appeal being filed.” In practical terms, this means that the official who determines good cause depends on which filing is late:

  • If the Request for Hearing is late an administrative law judge (ALJ) determines good cause
  • If the Request for Review of Hearing Decision is late, the Appeals Council determines good cause
  • If the deadline to file in federal court was missed, the Appeals Council again determines good cause

What Excuses Amount to “Good Cause”

There are SSA regulations describing, at general level, what amount to “good cause”:

  • The specific circumstances which led to the untimely filing
  • Whether the claimant was misled by any action of the SSA
  • Whether the claimant understood the time requirement

A more specific regulation provides that SSA will consider whether the claimant had any physical, mental, educational, or linguistic limitations—including any lack of facility with the English language–which prevented a timely filing, or which prevented the claimant from understanding or knowing about the need to file a timely request for review.

SSA has issued a Ruling on the lack of mental capacity, which states that tardiness will be excused when claimants lack the capacity to understand the procedures for requesting review, and had no one legally responsible for prosecuting the claim, such as “a parent of a claimant who is a minor, legal guardian, attorney, or other legal representative.” In applying this standard of mental incapacity, it doesn’t matter how much time has passed since the decision the claimant wants to appeal.

Reasonable doubt about the claimant’s capacity is resolved in favor of the claimant.

Get Social Security Disability Help

Establishing good cause is something best left to an experienced disability attorney in San Diego. Get the help you need to protect your right to benefits; if you need a lawyer for ssi appeals, call George Heppner and Aline Gaba at (619) 338-9000.

RELATED: Why Applying for Disability isn’t always easy

Social Security Hearings

If you have to appeal your denial for Social Security disability benefits in a hearing before an administrative law judge, you may be anxious about your hearing and curious as to what you should expect. Social security hearings are complicated. Here’s an explanation of the process from a high level, and an overview of what you can do to make it run smoothly.

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