Langerhans Cell Histiocytosis

Langerhans cell histiocytosis (“LCH”) is a rare disorder that is treated like a cancer, but is an autoimmune disorder in which immune cells begin to overproduce and attack the body instead of fighting infection. LCH creates excessive histiocyte cells, which normally help the immune system destroy foreign materials and fight infection. The extra histiocytes can form tumors, or cause pain and swelling and other complications, such as fractures or secondary compression of the spinal cord. 

Like many types of cancer, the Social Security Administration (“SSA”) recognizes that LCH is such a serious medical condition that it gets expedited review as a potential Compassionate Allowance. Compassionate Allowances allow the SSA to identify medical conditions that invariably qualify for Social Security Disability (“SSD”) benefits based on minimal objective medical information. 

Once objective diagnostic testing confirms the presence of a condition on the Compassionate Allowance list, the SSA usually approves SSD benefits without any further inquiry. In other words, the SSA approves benefits based upon the presence of the condition. Meeting a listing even requires showing that a serious medical condition has reached a certain severity level. 

I represent a 53 year old restaurant manager with LCH whose SSD application was approved two months after it was filed, and less than a week after I submitted reports from the claimant’s two doctors providing for the LCH diagnosis.

IMA Disability Services

Typing “IMA Disability Services” (“IMA”) in the search box on my blog page will reveal that I probably have written about IMA more than any other topic. 

I was notified that the Social Security Disability (“SSD”) application of one of my client’s, a 54 year old custodian with back and knee problems, was approved today. On June 13, 2014, July 8, 2014, July 28, 2014, and July 29, 2014, the State agency sent my client letters stating that he had to be examined by IMA. Moreover, IMA telephoned my office and stated that they can schedule an exam and, they don’t have to send my office a letter. 

Social Security has paid IMA millions of dollars to examine disability claimants. IMA is charged with knowing the rules and regulations for scheduling and performing exams as part of its contractual obligation for the exclusive right to perform the exams for Social Security. IMA is obligated to send written notification to claimants when scheduling exams. 

Perhaps more importantly, when applying, I notify Social Security that neither they nor the State Agency are authorized to communicate with the claimant directly, and I cite the applicable sections of the POMS, where the attorney must be contacted after advising that the claimant does not want to be contacted by the State agency directly. As far as I am concerned, if I do not receive written notification that the State agency wants a claimant to attend an exam, then it was never scheduled. Notwithstanding the above, despite the fact that IMA sent four letters demanding that the claimant attend its exam, and despite the fact that IMA insisted that it was imperative for the claimant be examined, his SSD application was approved today, three months after it was filed.

Federal Court Reverses CIGNA

U.S. District Court Judge Bianco reversed the termination of long term disability (“LTD”) benefits yesterday by CIGNA. CIGNA claimed that it could terminate my client’s LTD benefits because he did not submit “time concurrent” evidence of disability. CIGNA’s in house shill, Dr. John Mendez, said that evidence was “time concurrent” if submitted within one month of CIGNA’s termination decision. 

Mendez testified at his deposition that the need for “time concurrent” evidence to establish disability was based on his “clinical experience, expertise, and knowledge.” Gary Person, who supervises CIGNA disability appeals, admitted during his deposition that neither the Policy, nor any other CIGNA document, required “time concurrent” evidence to establish disability. Judge Bianco accepted my argument that since CIGNA’s Disability Policy did not state that “time concurrent” evidence was required, it could not provide a basis to terminate Plaintiff’s LTD benefits. 

Judge Bianco also agreed that CIGNA failed to identify any affirmative finding that the claimant’s condition improved to justify terminating LTD benefits. Since CIGNA had previously found the claimant was disabled, Judge Bianco found the claimant remained disabled because CIGNA terminated LTD benefits based upon a purported absence of evidence, as opposed to affirmative evidence showing the claimant got better. Judge Bianco added that implying that the claimant had improved because he took an overseas trip was unpersuasive selective cherry-picking.

SSD for RSD

Reflex Sympathetic Dystrophy (“RSD”), which is also known as Complex Regional Pain Syndrome (CRPS), is believed to be a nervous system malfunction that develops in response to trauma, and affects so many people that the Social Security Administration (the “SSA”) promulgated a special rule for it. 

I represent a 46 year old foreman working for a boat manufacturer with RSD whose application for Social Security Disability (“SSD”) benefits was approved today without the need for a hearing. While the claimant had submitted reports that documented the medical findings and resulting functional restrictions, the SSA did not approve the SSD benefits until the claimant submitted treatment records from the his orthopedist. 

The treatment records merely corroborated the evidence that had already been submitted. It remains unclear if the records were requested for the sake of completeness, or whether the SSA was attempting to see if there was anything in the records that would contradict the supporting evidence already in the file.

State Agency Waste and Delay

The State Agency makes the initial decision when you apply for Social Security Disability (“SSD”) benefits. Unfortunately, the vast majority of the time, it is a clerk, not a doctor, who makes the decision for the State agency. As you can imagine, those clerks usually make the wrong decision. Even worse, sometimes the clerks go out of their way to avoid approving SSD applications. 

I represent a 49 year old pharmaceutical manager with depression. The State agency clerk named T. Cotman denied the application on the grounds that the claimant’s psychiatrist did not send treatment notes to substantiate her opinions about the claimant’s mental limitations. The psychologist had submitted a report that specifically identified the medical findings supporting her restrictions and limitations due to the claimant’s depression. However, Cotman purged that report from the claimant’s file. On appeal, a copy of the report, together with the Electronic Records Express receipt showing that the State agency received it on November 23, 2012 at 2:51 PM EST, was resubmitted. 

The psychologist’s report showed that the claimant met the listing for depression. Based solely upon that report, the claimant’s SSD application should have been approved. The administrative law judge (“ALJ”) approved the claimant’s SSD application today based upon that report; as the psychologist refused to produce the treatment records on confidentiality grounds. The ALJ did have a Social Security psychologist review the report, who opined it showed the claimant met the listing. 

If Cotman had asked a Social Security psychologist to review the report, instead of purging it from the file, then the claimant’s application would have been approved more than a year earlier. Moreover, it would have prevented the hearing office and ALJ from having to expend their time and resources to do precisely what the State agency was obligated to do.

Lyme Disease

Lyme Disease is an infection caused by bacteria called Borrelia burgdorferi, which can lead to chronic encephalomyelitis. There are laboratory blood test findings that can provide objective support for the diagnosis. However, whether Lyme is considered disabling is a function of the severity of its symptoms.

I represent a 48 year old woman from Virginia with Lyme Disease that worked as an engineer, whose Social Security Disability (“SSD”) application was approved today without a hearing. The key was that the claimant was treating with the right specialist, dual board certified in Infectious Disease and Internal medicine, who prepared a very detailed narrative report, which explained why the treatment, objective and subjective medical evidence, precluded the claimant from functioning in a full time capacity. 

Many disability adjudicators are predisposed to reject disability claims based upon Lyme Disease, and frequently even question the validity of the disease itself. The narrative report was expensive, but still represented less than one month’s SSD benefits.

SSD Benefits for Hearing Loss

Can you receive Social Security Disability (“SSD”) benefits if you have problems hearing but are not deaf? The answer is yes. Perhaps the tougher question is how do you establish your entitlement to SSD benefits when you have problems hearing but are not deaf. Most claimants establish their entitlement to SSD benefits by showing how their medical conditions prevent them from performing the physical or mental demands of work. For example, claimants with back or knee problems show that their conditions prevent them from being able to sit or stand long enough to work. 

Showing how a hearing problem prevents you from doing the physical or mental demands of work is very difficult. An alternative way of establishing entitlement to SSD benefits is by demonstrating you meet the criteria of a listing. There is a listing, numbered 2.10 specifically for hearing loss.

Clearly documented medical records are needed to meet the listing based on hearing loss. Listings for many impairments are inexplicably overlooked or rejected. However, because the listing for hearing loss is based on meeting test data, there is no wiggle room for rejecting that the claimant meets the listing. 

I represent an attorney whose SSD claim was approved today. I obtained a report from the claimant’s otolaryngologist detailing why the claimant met listing 2.10. Notably, SSD was awarded without the claimant even being asked to attend a consultative examination.