Getting Social Security Disability Benefits

Jacques Chambers, CLU
Christine Kukka

Social Security offers several types of monthly benefits for disabled people: Social Security Disability Insurance (SSDI); Supplemental Security Income (SSI); as well as disability benefits for disabled widows, children, and adult children disabled since childhood. While each program has its own requirements for eligibility, they all use the same definition of total disability and the same method to determine if someone is "disabled enough" to merit benefits.

Under Social Security, a person is considered disabled if:

(1) Due to a medical condition he/she is unable to perform the tasks of a job for which he/she is suited,
(2) The condition has or will last for at least twelve months or is expected to result in death.
More than half of all first-time applications for disability benefits are denied, not because the disability definition is difficult to meet, but because the applicant didn't understand the disability determination process and didn't provide the information it needed to award Social Security benefits.

Denial of Social Security benefits appears to affect people with hepatitis B even more, for several additional reasons:

• Because hepatitis B and C are relatively new disabling conditions, Social Security hasn't developed an organized approach to reviewing hepatitis-related claims;

• Hepatitis B symptoms can vary from none at all to complete debilitation, so the diagnosis of hepatitis B alone doesn't have much impact in determining disability; and,

• Many of the most common symptoms of viral hepatitis are "subjective"; they can't be readily measured by a laboratory test. Examples include fatigue, headaches, memory loss, and depression. Therefore, medical records alone often don't adequately describe the functional problems an applicant has when trying to hold down a job.

People with hepatitis B rarely suddenly awake one day to find themselves unable to work. Typically, one's ability to work gradually declines. Work becomes more and more difficult; finding the energy to work is more and more time-consuming. Some people reach a point where they only work and spend the remainder of their time in bed trying to regain enough strength to return to work.

If you believe the time to apply for Social Security Disability is approaching, especially within the next few months, there are two things you can do before you stop work to increase your chance of getting your claim approved the first time around:

(1) Learn how Social Security processes a claim for disability; and,

(2) Assemble and review the "medical evidence" that will be used to determine if you are disabled by their definition.


Learn How Social Security Processes a Claim for Disability

Social Security has put a lot of information about the disability process on their website at www.ssa.gov.

For example, in examining a disability claim there are five questions that a Disability Analyst seeks the answers to:

1. Are you working?

2. Is there a medical problem that affects your ability to work to any degree?

3. Is your condition found in the Listing of Impairments? (more on that below)

4. Can you do the work you did previously?

5. Can you do any other type of work?

To be eligible for benefits, the answer to #1 must be "No," and the answer to #2 must be "Yes."

If the answer to #3 is "Yes," your claim will be approved. If not, then both #4 and #5 must be "No."

To facilitate the process and to maintain some uniformity throughout the country, Social Security publishes a book called, Disability Evaluation Under Social Security, or "The Blue Book," which includes a Listing of Impairments that is available at SSA's website. If your medical condition is listed in that Listing of Impairments, and it meets the criteria given, then your claim is routinely approved.

The listing, unfortunately, does not directly deal with hepatitis B, although there is a listing for Chronic Liver Disease in the adult listings that includes chronic active hepatitis. However, because the symptoms can vary substantially, the listing also includes some guidelines on how severe the condition must be:

"5.05 Chronic liver disease (e.g., portal, postnecrotic, or biliary cirrhosis; chronic active hepatitis; Wilson's disease). With:

A. Esophageal Varices (demonstrated by endoscopy or other appropriate medically acceptable imaging) with a documented history of massive hemorrhage attributable to these varices. Consider under disability for 3 years following the last massive hemorrhage; thereafter, evaluate the residual impairment; or

B. Performance of a shunt operation for esophageal varices. Consider under a disability for 3 years following surgery; thereafter, evaluate the residual impairment; or

C. Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater persisting on repeated examinations for at least 5 months; or

D. Ascites, not attributable to other causes, recurrent or persisting for at least 5 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or

E. Hepatic encephalopathy. Evaluate under the criteria in Listing 12.02; or

F. Confirmation of chronic liver disease by liver biopsy (obtained independent of Social Security disability evaluation) and one of the following:

a. Ascites not attributable to other causes, recurrent or persisting for at least 3 months, demonstrated by abdominal paracentesis or associated with persistent hypoalbuminemia of 3.0 gm. per deciliter (100 ml.) or less; or

b. Serum bilirubin of 2.5 mg. per deciliter (100 ml.) or greater on repeated examinations for at least 3 months; or

c. Hepatic cell necrosis or inflammation, persisting for at least 3 months, documented by repeated abnormalities of prothrombin time and enzymes indicative of hepatic dysfunction."

In the Children's Listings, there is also no mention of hepatitis B, but it does address liver disease.

"105.05 Chronic Liver Disease. With one of the following:

A. Inoperable biliary atresia demonstrated by appropriate medically acceptable imaging or surgery; or

B. Intractable ascites not attributable to other causes, with serum albumin of 3.0 gm./100 ml. or less; or
C. Esophageal varices (demonstrated by endoscopy or other appropriate medically acceptable imaging); or

D. Hepatic coma, documented by findings from hospital records; or

E. Hepatic encephalopathy. Evaluate under the criteria in 112.02; or

F. Chronic active inflammation or necrosis documented by SGOT persistently more than 100 units or serum bilirubin of 2.5 mg. percent or greater."

If your medical condition meets one of these criteria, your claim should be approved. However, it will help if your physician states the condition in a letter to Social Security, using terms and results as shown in the Listing.

If your condition does not meet any of these criteria, all is not lost. It is still possible to have your claim approved if the symptoms you exhibit are as severe as one of the listings. If your symptoms clearly show that the answers to questions #4 & 5 are both no, your claim will also be approved.

Usually, however, more medical evidence will be required to get the claim accepted. In that case, you should make sure you submit all the medical evidence that you can with the application.

Assemble and Review Your Medical Evidence

Medical evidence is what Social Security will use to determine whether or not you are disabled by their standards. Clearly your doctor's records are important, but it should be noted that Social Security is also interested in your symptoms and how they impair your ability to function.

Start by making a list of all your symptoms. Then, as you review the medical evidence, you can make sure all symptoms are covered. Leave this list out where you can see it, on the kitchen counter or dining room table, for a few days. If you have been dealing with hepatitis B for any length of time, there are probably symptoms that you have accommodated for so long that you've forgotten they are symptoms.

Also, Social Security looks at all of your symptoms to see if they are related to hepatitis B, or another medical condition you may have. Side effects of medication are also considered symptoms and should be included. It is important that Social Security knows all your symptoms as well as all the ways they affect your ability to function.

The most important evidence are the records of your medical providers. They can include the records of your primary care physician and specialist, as well as the records of your therapist, chiropractor, acupuncturist and other medical practitioner. "Non-medical establishment" providers won't carry the clout of "regular" doctors, but they can support your claim by documenting your symptoms and your efforts to relieve them.

Because disability determination focuses on your symptoms and how they prevent you from working, it is a good idea to make sure your physicians record your symptoms during each visit, even if it's repetitive.

To speed up processing time, it is also recommended that you take copies of your medical records when you have your initial interview with Social Security.

While the medical records of your providers are the primary source of evidence in reviewing your claim, there are other documents and records that can help you. These include:

1. Questionnaires - Once you apply for disability benefits, the Disability Analyst will send you questionnaires. They may ask about pain, fatigue, your daily activities, or other conditions or symptoms. These questionnaires are your opportunity to transform the data from your medical records into robust descriptions of the problems your condition causes you at work and during your daily routine. Do not skimp on these or rush through them quickly. Take your time, add extra sheets of paper if needed, label appropriately, and thoroughly describe exactly how your symptoms affect your routine.

2. Letters from Physicians - Ask each of your doctors to write a thorough summary of your condition. They should effectively link your medical condition and test results to the symptoms you are experiencing. To adequately do the job, each letter should be several pages long, don't settle for just a couple of paragraphs.

3.Third Party Testimony - These are letters from friends, family, or co-workers that describe their observations of your problems as you try to work and function. These should be anecdotes and descriptions about what they have observed in your performance. One of the best is a copy of a "write-up" by your supervisor on your deteriorating performance from your personnel file. Not everyone will have one of these as many people work that much harder to make sure their performance doesn't deteriorate. Letters from a spouse or housemate co-worker on how your activities and abilities have changed due to your condition are good also. A description through anecdotes about how your ability to function has deteriorated should be the goal. While these alone won't get your claim approved, they do help provide a good picture of how your medical condition affects your activities.

4. Symptom Diary - This can be an especially helpful tool when the symptoms are primarily subjective. Psychologically it is not fun to do, but it can help confirm the impact of the symptoms on your activities. A symptom diary is simply a daily log, in which you enter the symptoms you experienced during the day, their severity including how long they lasted, and their impact on your daily activities, such as requiring you to rest, cancel planned appointments, etc.

This seems like a lot of work just to get benefits you deserve, but remember, Social Security is so big they can't be bothered with "what's fair" or "what you deserve." You need to know their rules and "play the game" by them. Making the effort with the initial application can help you avoid having to drag yourself through a year or more of appeals and sharing your award with an attorney, and it will save you time, money, and lots of stress.

One advocate who has helped several HCV- and HBV-infected people apply for Social Security reported, "Be persistent, keep all medical reports and send copies with every re-application. Go to every hearing! Appeal, appeal and appeal again."

[Jacques Chambers, CLU, and his company, Chambers Benefits Consulting, have over 35 years of experience in health, life and disability insurance and Social Security disability benefits. For the past 12 years, he has been assisting people with their rights, problems, and other issues concerning benefits and disability. He can be reached at jacques@helpwithbenefits.com or through his website at: http://www.helpwithbenefits.com.]


For more information about the hepatitis B immunization, visit the following websites.

Centers for Disease Control and Prevention website on hepatitis B immunization: http://www.cdc.gov/ncidod/diseases
/hepatitis/b/factvax.htm

Immunization Action Coalition provides extensive information on all childhood immunizations, including hepatitis B.
http://www.immunize.org

National Network for Immunization Safety provides up-to-date, science-based information about immunization.
http://www.immunizationinfo.org

American Academy of Pediatrics, an organization of 57,000 pediatricians, issues recommendations to ensure childhood health and safety.
http://www.aap.org

For more information about the hepatitis B, visit the following websites.

Hepatitis B Foundation:
http://www.hepb.org

HIVandHepatitis.com
http://hivandhepatitis.com

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