Disability evaluation under social security a handbook for physicians

Update on Our Reentry Plans. Learn about Emergency Assistance for Homeowners and Renters. Existence of an impairment By law, SSA needs specific medical evidence to establish that a claimant has an impairment.

Severity Once the existence of an impairment is established, SSA considers all evidence from all medical and nonmedical sources to assess the extent to which a claimant's impairment s affects his or her ability to function in a work setting; or in the case of a child, the ability to function compared to that of children the same age who do not have impairments.

Consultative Examinations If the evidence provided by the claimant's own medical sources is inadequate to determine if he or she is disabled, additional medical information may be sought by recontacting the medical source for additional information or clarification, or by arranging for a consultative examination CE. The history, examination, evaluation of laboratory test results, and the conclusions will represent the information provided by the consultant who signs the report.

Evidence Relating to Symptoms In developing evidence of the effects of symptoms, such as pain, shortness of breath, or fatigue, on a claimant's ability to function, SSA investigates all avenues presented that relate to the complaints.

These include evidence about: the claimant's daily activities; the location, duration, frequency, and intensity of the pain or other symptom; precipitating and aggravating factors; the type, dosage, effectiveness, and side effects of any medication; treatments, other than medications, for the relief of pain or other symptoms; any measures the claimant uses or has used to relieve pain or other symptoms; and other factors concerning the claimant's functional limitations due to pain or other symptoms.

Diffuse cutaneous systemic sclerosis. In diffuse cutaneous systemic sclerosis also known as diffuse scleroderma , major organ or systemic involvement can include the gastrointestinal tract, lungs, heart, kidneys, and muscle in addition to skin or blood vessels. Localized scleroderma linear scleroderma and morphea. However, this type of scleroderma can persist into adulthood.

To assess the severity of the impairment, we need a description of the extent of involvement of linear scleroderma and the location of the lesions. For example, linear scleroderma involving the arm but not crossing any joints is not as functionally limiting as sclerodactyly scleroderma localized to the fingers. Linear scleroderma of a lower extremity involving skin thickening and atrophy of underlying muscle or bone can result in contractures and leg length discrepancy.

In such cases, we may evaluate your impairment under the musculoskeletal listings 1. We evaluate these variants of the disease under the criteria in the musculoskeletal listings 1. Documentation of systemic sclerosis scleroderma. Documentation involves differentiating the clinical features of systemic sclerosis scleroderma from other autoimmune disorders.

However, there may be an overlap. Polymyositis and dermatomyositis Polymyositis and dermatomyositis are related disorders that are characterized by an inflammatory process in striated muscle, occurring alone or in association with other autoimmune disorders or malignancy. The most common manifestations are symmetric weakness, and less frequently, pain and tenderness of the proximal limb-girdle shoulder or pelvic musculature. There may also be involvement of the cervical, cricopharyngeal, esophageal, intercostal, and diaphragmatic muscles.

Documentation of polymyositis and dermatomyositis. Generally, but not always, polymyositis is associated with elevated serum muscle enzymes creatine phosphokinase CPK , aminotransferases, and aldolase , and characteristic abnormalities on electromyography and muscle biopsy. In dermatomyositis there are characteristic skin findings in addition to the findings of polymyositis. When you have had electromyography or muscle biopsy for polymyositis or dermatomyositis, we will make every reasonable effort to obtain reports of the results of that procedure.

However, we will not purchase electromyography or muscle biopsy. Additional information about how we evaluate polymyositis and dermatomyositis under the listings. Weakness of your shoulder girdle muscles may result in your inability to perform lifting, carrying, and reaching overhead, and also may seriously affect your ability to perform activities requiring fine movements.

We evaluate these limitations under Undifferentiated and mixed connective tissue disease This listing includes syndromes with clinical and immunologic features of several autoimmune disorders, but which do not satisfy the criteria for any of the specific disorders described.

For example, you may have clinical features of SLE and systemic vasculitis, and the serologic blood test findings of rheumatoid arthritis. Documentation of undifferentiated and mixed connective tissue disease. Undifferentiated connective tissue disease is diagnosed when clinical features and serologic blood test findings, such as rheumatoid factor or antinuclear antibody consistent with an autoimmune disorder are present but do not satisfy the criteria for a specific disease.

Mixed connective tissue disease MCTD is diagnosed when clinical features and serologic findings of two or more autoimmune diseases overlap. Inflammatory arthritis The spectrum of inflammatory arthritis includes a vast array of disorders that differ in cause, course, and outcome.

Clinically, inflammation of major joints in an upper or lower extremity may be the dominant manifestation causing difficulties with walking or fine and gross movements; there may be joint pain, swelling, and tenderness. The arthritis may affect other joints, or cause less limitation in walking or fine and gross movements.

However, in combination with extra-articular features, including constitutional symptoms or signs severe fatigue, fever, malaise and involuntary weight loss , inflammatory arthritis may result in an extreme limitation. Inflammatory arthritis involving the axial spine spondyloarthropathy. In adults, inflammatory arthritis involving the axial spine may be associated with disorders such as:. Inflammatory arthritis involving the peripheral joints. In adults, inflammatory arthritis involving peripheral joints may be associated with disorders such as:.

Documentation of inflammatory arthritis. Generally, but not always, the diagnosis of inflammatory arthritis is based on the clinical features and serologic findings described in the most recent edition of the Primer on the Rheumatic Diseases published by the Arthritis Foundation.

How we evaluate inflammatory arthritis under the listings. In Extra-articular impairments may also meet listings in other body systems.

Involvement of the lacrimal and salivary glands is the hallmark feature, resulting in symptoms of dry eyes and dry mouth, and possible complications, such as corneal damage, blepharitis eyelid inflammation , dysphagia difficulty in swallowing , dental caries, and the inability to speak for extended periods of time.

Involvement of the exocrine glands of the upper airways may result in persistent dry cough. Severe fatigue and malaise are frequently reported.

Primary immune deficiency disorders are seen mainly in children. However, recent advances in the treatment of these disorders have allowed many affected children to survive well into adulthood. Occasionally, these disorders are first diagnosed in adolescence or adulthood. Documentation of immune deficiency disorders. The medical evidence must include documentation of the specific type of immune deficiency.

Documentation may be by laboratory evidence or by other generally acceptable methods consistent with the prevailing state of medical knowledge and clinical practice. Immune deficiency disorders treated by stem cell transplantation. Evaluation in the first 12 months. If you undergo stem cell transplantation for your immune deficiency disorder, we will consider you disabled until at least 12 months from the date of the transplant. Evaluation after the month period has elapsed.

After the month period has elapsed, we will consider any residuals of your immune deficiency disorder as well as any residual impairment s resulting from the treatment, such as complications arising from:.

Medication-induced immune suppression. Medication effects can result in varying degrees of immune suppression, but most resolve when the medication is ceased. However, if you are prescribed medication for long-term immune suppression, such as after an organ transplant, we will evaluate:. Residuals from the organ transplant itself, after the month period has elapsed.

Any individual with HIV infection, including one with a diagnosis of acquired immune deficiency syndrome AIDS , may be found disabled under Definitive documentation of HIV infection.

We may document a diagnosis of HIV infection by positive findings on one or more of the following definitive laboratory tests:. We will make every reasonable effort to obtain the results of your laboratory testing. Other acceptable documentation of HIV infection. We may also document HIV infection without definitive laboratory evidence. To be persuasive, this report must state that you had the appropriate definitive laboratory test s for diagnosing your HIV infection and provide the results.

The report must also be consistent with the remaining evidence of record. For example, we will accept a diagnosis of HIV infection without definitive laboratory evidence of the HIV infection if you have an opportunistic disease that is predictive of a defect in cell-mediated immunity for example, toxoplasmosis of the brain or Pneumocystis pneumonia PCP , and there is no other known cause of diminished resistance to that disease for example, long-term steroid treatment or lymphoma.

In such cases, we will make every reasonable effort to obtain full details of the history, medical findings, and results of testing. Documentation of the manifestations of HIV infection. Definitive documentation of manifestations of HIV infection. We may document manifestations of HIV infection by positive findings on definitive laboratory tests, such as culture, microscopic examination of biopsied tissue or other material for example, bronchial washings , serologic tests, or on other generally acceptable definitive tests consistent with the prevailing state of medical knowledge and clinical practice.

Other acceptable documentation of manifestations of HIV infection. We may also document manifestations of HIV infection without definitive laboratory evidence. To be persuasive, this report must state that you had the appropriate definitive laboratory test s for diagnosing your manifestation of HIV infection and provide the results.

For example, many conditions are now commonly diagnosed based on some or all of the following: Medical history, clinical manifestations, laboratory findings including appropriate medically acceptable imaging , and treatment responses. Disorders associated with HIV infection Multicentric Castleman disease MCD, This widespread involvement distinguishes MCD from localized or unicentric Castleman disease, which affects only a single set of lymph nodes. While not a cancer, MCD is known as a lymphoproliferative disorder.

Its clinical presentation and progression is similar to that of lymphoma, and its treatment may include radiation or chemotherapy. We require characteristic findings on microscopic examination of the biopsied lymph nodes or other generally acceptable methods consistent with the prevailing state of medical knowledge and clinical practice to establish the diagnosis.

Localized or unicentric Castleman disease does not meet or medically equal the criterion in Imaging tests for example, MRI of the brain, while not diagnostic, may show a single lesion or multiple lesions in the white matter of the brain. We require characteristic findings on microscopic examination of the cerebral spinal fluid or of the biopsied brain tissue, or other generally acceptable methods consistent with the prevailing state of medical knowledge and clinical practice to establish the diagnosis.

Primary effusion lymphoma PEL, We require characteristic findings on microscopic examination of the effusion fluid or of the biopsied tissue from the affected internal organ, or other generally acceptable methods consistent with the prevailing state of medical knowledge and clinical practice to establish the diagnosis.

Progressive multifocal leukoencephalopathy PML, Clinical findings of PML include clumsiness, progressive weakness, and visual and speech changes. Personality and cognitive changes may also occur. We require appropriate clinical findings, characteristic white matter lesions on MRI, and a positive PCR test for the JC virus in the cerebrospinal fluid to establish the diagnosis. We also accept a positive brain biopsy for JC virus or other generally acceptable methods consistent with the prevailing state of medical knowledge and clinical practice to establish the diagnosis.

Pulmonary Kaposi sarcoma Kaposi sarcoma in the lung, Other internal KS tumors for example, tumors of the gastrointestinal tract have a more variable prognosis. We require characteristic findings on microscopic examination of the induced sputum, bronchoalveolar lavage washings, or of the biopsied transbronchial tissue, or by other generally acceptable methods consistent with the prevailing state of medical knowledge and clinical practice to establish the diagnosis. CD4 measurement To evaluate your HIV infection under This measurement must occur within the period we are considering in connection with your application or continuing disability review.

If you have more than one measurement of your absolute CD4 count within this period, we will use your lowest absolute CD4 count. Measurement of CD4 and either body mass index or hemoglobin These measurements must occur within the period we are considering in connection with your application or continuing disability review. If you have more than one measurement of your CD4 absolute count or percentage , BMI, or hemoglobin within this period, we will use the lowest of your CD4 absolute count or percentage , BMI, or hemoglobin.

The date of your lowest CD4 absolute count or percentage measurement may be different from the date of your lowest BMI or hemoglobin measurement. We calculate your BMI using the formulas in 5. Complications of HIV infection requiring hospitalization Complications of HIV infection may include infections common or opportunistic , cancers, and other conditions. Examples of complications that may result in hospitalization include: Depression; diarrhea; immune reconstitution inflammatory syndrome; malnutrition; and PCP and other severe infections.

Social Security Disability Planner for applying for disability benefits online. Social Security representatives in the field offices usually obtain applications for disability benefits in person, by telephone, by mail, or by filing online. The "claimant" is the person who is requesting disability benefits. The field office is responsible for verifying non-medical eligibility requirements, which may include age, employment, marital status, or Social Security coverage information.

The field office then sends the case to a DDS for evaluation of disability. The DDSs, which are fully funded by the Federal Government, are State agencies responsible for developing medical evidence and rendering the initial determination on whether or not a claimant is disabled or blind under the law. Usually, the DDS tries to obtain evidence from the claimant's own medical sources first.