The Social Security Disability Attorneys at the San Diego Disability Law Group recently represented a 47 year old woman with Breast Cancer. When she first contacted our office her claim for disability benefits had already been denied by the Social Security Administration and the time limit to file a Request For Reconsideration had already passed.
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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.
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…
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.
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.
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.