The following questions are those most frequently asked by persons who suffer from scleroderma, and who are in search of disability benefits from the Social Security Administration.
Q: What does the term "disability" mean to the Social Security Administration?
For purposes of entitlement to disability benefits, the term "disability" is defined as the inability to engage in any form of substantial gainful activity (e.g. work) by reason of any medically determinable physical or mental impairment which has lasted (or can be expected to last) for a continuous period of 12 months or more, or which can be expected to result in death. It is important to note that the Administration's definition of "disability" precludes a person from being able to do any work, not just the work they have done in the past.
A warehouse worker who has hurt his back, for example, may not be able to continue working in a warehouse (which requires heavy lifting), but he may be able to sit at a table assembling small items. The disability must also be "medically determinable," meaning that symptoms alone will not justify a finding of disability. If a person's hands shake, objective medical evidence of the existence of a condition which would cause a person's hands to shake must exist.
Q: How does the Social Security Administration regard scleroderma?
The Social Security Administration knows that scleroderma can be a medical problem with potentially disastrous manifestations. Congress has written special provisions into the law regarding scleroderma. These provisions are contained in that section of the Social Security Law known as the "listings." The "listings" are so named because this section of the law is really a "list" of possible disabilities - and scleroderma is one of them.
The particular listing which applies to scleroderma is known as Listing 14.04, Systemic sclerosis and scleroderma. A copy of Listing 14.04 is attached to the end of this article. Listing 14.04 provides a standard of severity. Any person who has scleroderma which is as severe as described in Listing 14.04 will automatically qualify for benefits. However, Listing 14.04 sets a very severe standard of severity. Generally, a person must suffer from scleroderma with significant and severe involvement of the respiratory system, or the cardiovascular system, or the digestive system, or the kidneys, or the muscles.
What if a person suffers from scleroderma, but not as severely as Listing 14.04 requires? Can one still qualify? The answer is yes. Any person who is prevented from working by his or her medical condition is disabled and qualifies for benefits. If you suffer from scleroderma and cannot work, you are entitled to help form Social Security. The problem you face is a problem of proof. You must prove that your condition would prevent you from working.
Q: How will the Social Security Administration decide whether my condition prevents me from working?
The Social Security Administration will conduct a very specific analysis to determine whether your medical condition prevents you from working. That analysis consists of asking five questions.
- First, the Administration will ask "are you working?" If you are working, you are not disabled, and your claim for benefits will be denied.
- Second, the Administration will ask "do you actually have scleroderma?" You must present medical records and test results which show that you actually have scleroderma. However, the mere fact of a diagnosis does not automatically qualify you for benefits. The Administration will go on to ask the other questions which follow.
- Third, the Administration will ask itself if your medical records and test results indicate that your scleroderma is severe enough to meet the requirements of Listing 14.04. If so, you automatically qualify. If not, the Administration will go on to ask the other following questions.
- Fourth, the Administration will ask if your scleroderma would prevent you from returning to the work that you have done in the past. If you are not so sick so as to prevent you from returning to your former work, you are not disabled, and your claim will be denied. If you are unable to return to any of your former jobs, then the Administration will ask one more question:
- Fifth, is there any other work you are capable of doing? If so, you will be denied. If not, you will be granted disability benefits.
Q: What if I cannot work, but the Social Security Administration denies my claim for benefits?
Don't give up. The Social Security Administration turns down many qualified applicants. You can appeal if you are denied, and many many persons receive benefits only after they appeal . If you are denied benefits after filing an application, your first appeal is called a "request for reconsideration." By filing this appeal, you ask the Social Security Administration to "reconsider" your application to see if they have made a mistake.
If you are denied a second time, you can request a hearing before a judge who is familiar with the law, and who does not work for the Social Security Administration. He will decide if the Social Security Administration properly analyzed your claim for benefits. The important point is don't give up. These days, the federal government does not have a lot of spare cash; and Congress feels that the Social Security Disability System is expensive and needs to be carefully controlled. This leads to a lot of institutional "inertia" which causes many deserving claims to be denied. But statistics show that the deserving claimant will be awarded benefits if he or she persists.
Q: If I have scleroderma, and if I really am too sick to work, what would an attorney advise me to do?
- Accept the fact that you are in a fight, and get yourself ready to fight it. This means roll up your sleeves. Get involved in your case and stay involved. Don't expect the judge to possess the wisdom of god. Don't expect your doctor or your lawyer to do everything for you. Ask questions, and keep asking them until you get clear answers. Don't be afraid to "push" those who are working with you. Follow up on requests and promises with phone calls. After all, its YOUR disease, YOUR treatment, and YOUR legal case.
- Get your doctor involved. The most important of the legal issues surround your medical condition. Lawyers and judges rely primarily on doctors to interpret the severity of your medical condition and to determine how it would limit you. Your doctor is your best expert. He has treated you and knows your condition best. So have a "heart to heart" conversation with your doctor. Get him or her "committed" to helping you by writing a report about your condition, providing medical records promptly when they are requested, and by working with your attorney when the need arises. Any lawyer will tell you that, incases such as these, a helpful treating physician is your single most powerful asset.
- Be prepared to recognize and deal with the emotional aspects of your condition. Suffering from scleroderma is a frightening thing. One often feels alone and isolated. If you find yourself seeking treatment for your emotional difficulties, don't feel embarrassed. Don't feel like you must hide this treatment from Social Security. Your Social Security claim is protected by the federal privacy laws. No one can get access to these records without your permission.
Q: Do I need a lawyer to help me with my claim?
Technically, a lawyer is not required. The SSA will provide assistance filling out the necessary forms. The judges, in most cases, make attempts to assure a fair hearing of the claim. Nonetheless, persons in pursuit of disability benefits face great legal challenges. Statistics show that a person who is represented by an attorney has a much better chance of obtaining benefits. Most attorneys who work exclusively on Social Security cases will take a case on a "contingency" basis, meaning that no fee is charged unless the case is won.