June 26, 2013 was a landmark moment for same-sex spouses in regards to applying for Social Security Disability; after reviewing the Defense of Marriage Act of 1996, the Supreme Court decided to adjust some of the concepts behind the act.  Originally, this act made it impossible for same-sex spouses to file for SSI Disability because it was illegal for the Social Security Administration to recognize their partnership as a legal marriage (which is required in order to file for Social Security spouse benefits).  Now, however, the Social Security Administration is working alongside the Justice Department to determine what rules need to be put in place to deal with same-sex spouse claims.  So far they have come up with 3 new policies regarding claims for retirement aged spouses, non-biological children, and transgender individuals.  The first states that retirement aged same-sex spouses may apply for SSI if they were both married and currently living in a state that identifies their marriage as a legal marriage.  The second policy states that if the same-sex couple’s non-biological child is found, by state, to be a possible successor of the parent(s) than they will be eligible for SSI benefits.   The final new policy behind the reformation of this act concludes that a transgender individual is only eligible if the state in which they are applying for SSI views their marriage as legitimate and legal after that individual had gender reconstruction.  Although the Social Security Administration has come up with some new policies after the June court decision, there are still more that are in the process such as: same-sex spousal widow claims, claims from same-sex couples who are not legally married but are in civil unions, and claims for those who are “younger than retirement age caring for an eligible child.”  These last few policies that have yet to be created are currently being worked on, though, so it will only be a matter of time before you will see these policies alongside the other three already created.

 

https://www.marketwatch.com/story/same-sex-couples-await-social-security-clarity-2013-09-20

Although it is difficult for a child with ADHD to be approved for SSI Disability benefits, those with severe ADHD who meet the SSI program’s requirements have a chance of being awarded benefits.  One of the first requirements is that your child shows all of the symptoms of ADHD, which include the following: severe hyperactivity, severe inattentiveness, and severe impulsiveness.  The first requirement is one that applies to both children under the age of 3 and children aging from 3-18 years of age.  Although the requirements are similar, they do differ for these two separate age groups.  Most children aren’t diagnosed with ADHD until they are older than 3 years old, which is why there is need for two separate age group requirements: those under the age of 3 years and those who range from 3 years to 18 years.

The latter group (3-18 years) must have evidence that they have extreme difficulty in at least two of the following four areas in comparison to their peers: issues in cognitive functions, personal functions, social functions, or issues with persistency/ concentration. As previously mentioned, there must be evidence of these difficulties such as medical treatment/documentation, evaluations or notes from teachers and parents regarding the child’s history with ADHD, or results from a type of standardized testing the measures the child’s abilities and/or development.

For children who are younger than 3 years old, the Social Security Administration looks for any evidence of developmental issues that result from ADHD symptoms.  They must see that your child has developmental delays in cognitive functions, personal functions, social functions, concentration, or in their fine motor development.  Being as this particular age group is younger and unlikely to be diagnosed with ADHD just yet, there is a much smaller chance of them being granted benefits.

A couple of other factors that will play into your child’s eligibility is whether or not they work and how well they do in school.  Much like with adults applying for Social Security, there is a limit on how much money a child could make a month all the while still being eligible.  Some older children may have jobs, if this is the case they cannot earn more than $1,040 per month and still be eligible.  In regards to school, the Social Security Administration needs to see how ADHD affects your child in their development.  If ADHD has such a negative effect on their school and learning, it could lead to further issues down the road.  So it is necessary that there is sufficient evidence (such as standardized tests, teacher notes, progress reports, etc.) to prove your child’s ADHD is disabling to their learning and developmental progress.

Having to gather all of the evidence needed to prove your child’s ADHD is disabling enough can be a headache, especially if there is only a small chance they will be approved for SSI Disability benefits.  However, it has been shown that having a lawyer represent your case has a higher approval rate compared to those who chose to represent themselves alone.  So, although chances are small, there is still hope for being approved.

 

https://www.disabilitysecrets.com/adhd-attention-deficit-social-security-disability.html

The first thing to keep in mind if you are incarcerated in prison is that you will not receive Supplemental Security Income (SSI) payments or benefits during the months you are imprisoned, nor are you immediately eligible upon release.  Once you have been incarcerated for 30 consecutive days, your benefits are suspended; if your spouse and/or children are still eligible, though, their benefits will continue. After 12 consecutive months, your benefits are terminated and upon release you must reapply for SSI payments and benefits with documents proving your release.  If you are released before 12 months have passed, your benefits can be reinstated after a month has passed since your release date. Before they can be reinstated, though, you will need to provide the local Social Security office a copy of your release documents.  In regards to your SSI payments, once you are released from prison your payments will start back up that same month. It is important to remember that you can’t receive benefits until you are actually released and have proven that to Social Security as well as prove you are still eligible.

If you were incarcerated before you were receiving SSI payments and benefits and would like to pursue Social Security, you may file while you are in prison. If the facility you are incarcerated at has a prerelease agreement with Social Security all you will need to do is talk with your facility about your desire to start an application for Social Security once your release date is known.  They will then be in touch with Social Security as to whether or not you are eligible.   You will then need to fill out an application months prior to your release date so Social Security is able to process it as soon as possible.  This is optimal because it will mean you can receive your benefits sooner than later after being released.

If the facility you are incarcerated at does not have a prerelease agreement, you will need to contact Social Security on your own once you have your release date.  All you need to do for this is get a hold of a representative there and inform them on your release date and that you would like to apply for SSI payments and benefits.  You will then receive an appointment upon release with a representative at the local office to discuss your eligibility and application process.

 

https://www.socialsecurity.gov/pubs/10133.html

Chapter 4

The First Call.

 

Wednesday, April 6, 2011.  The Law Firm.  8:30 a.m.

“Hoglund Law Offices, Natalia speaking.  Are you a current client or a new client?”

Squeezing the phone receiver hard, Denise responded.  “New client.  I have questions about Social Security.”  Her left palm was wet holding the phone.

“OK,” said the calm voice on the line.  “I’ll put you through to one of our paralegals.”  Hold music followed.

Twenty seconds later:  “Hi, this is Shannon.  Is this Denise?  I have some questions for you.”

Denise understood that this was a screening call.  She was going to be asked questions to determine if she had a good case.  She took a breath.

Shannon continued.  “We are a law firm, and we keep everything confidential.  Let’s start with your full name and address.”  Shannon had a nice, almost cheery, voice.  Denise explained her diagnosis, treatment, and work history.  Denise felt like she was being heard.

“Thank you Denise.  Let me get this information to one of our attorneys to review.  Please hold.”  That startled Denise.  Her throat tensed up.  What if they won’t help me?  What if it actually does cost money up front?  Here it goes.  Denise closed her eyes and took some deep breaths.

The hold music played.  A Spanish guitar on a bad radio signal.  A few minutes later, Shannon came back.  She was bright and cheery – again.

“Denise, you there?”

“Yes.”  She swallowed hard.

“I spoke with the attorney, and he said we could help you.”

Just like that.  Denise felt a sob rising from within her chest.  Her eyes welled up.  “Thank you so much.”

“No problem.  It’s my job.  Remember, we only charge one quarter of back pay if you win.”  Emily was right, she thought.  “Unlike ome other firms, we charge for nothing else.  Hang in there.  You’ll get a packet of paperwork we’ll need you to sign.  We’ll send it out right away.  Please hold.  I’ll get Andrew the attorney on the line.”

This pause was shorter.  A few muddy guitar chords played.  “This is Andrew.  Is this Denise?”

“Yes.”  Things were happening fast.

“I was the attorney here reviewing your claim.  I decided we could help you.  I’ve been doing this work for over 20 years.”  Denise relaxed.  He knows what he’s doing.  “In my experience, Social Security denied you before, but you turned 50 later this year.  Your age now makes a big difference.”

He continued.  “We need to prove you are limited to sedentary work, and you cannot return to your past kind of work full-time.”  He explained the two-year Social Security appeal process, how his firm worked, and then he said, “Does your neurologist know you are applying for disability?”

“Yes, I just brought this up at my last appointment yesterday.”

“Good.  From your treatment and history, it’s likely your doctor knows you are doing as much as you can to get better.  Next time you see your doctor, can you ask him to make sure your records are clear about how you are limited by MS?  We’ll likely ask your doctor for input about how you are doing later.”  Input?  Denise thought.  Law is mysterious.

She answered quickly, “Sure.  He knows me real well.  I just did more testing.”

“Excellent.  It is important that your true limitations are clear in the medical record.  This is what we argue about with doctors at hearings.”  Doctors at hearings?  She was confused.

Andrew spoke with Denise further, answering different questions, especially about Social Security hearings.  “Eventually your case leads to a hearing with a judge,” he said.  “Don’t worry.  It isn’t Judge Judy.”  Denise laughed.  “That’s TV.  You get a private hearing with us there with you.  We are a real law firm, not a corporation, and we plan to hang in there with you.”  Do companies without lawyers do this? Denise thought.  “Our attorneys spend almost every day with judges in our area.  One of us will be with you.”

“You applied before, but never went to a hearing, right?” Andrew asked.

“Right, is that a problem?”

“No,” he said.  “Just verifying.  Most people are denied when they apply.  Social Security contracts with state agencies to filter people out at the first two steps.  They are backward enough to mostly review their approvals.  We find many of their denials inconsistent.  It’s our job to point these problems out at every hearing.  And we often do.”

Denise spoke up.  “I had the chance to buy long-term disability at the hospital I worked at.  I didn’t.  Is that a problem?”

“No.  Private long-term disability insurance has changed since the mid-90’s.  If you got it after that, and then got approved here for Social Security Disability, you have to pay them back.”

“Really?”

“Yes.  The federal government should stop what’s called the ‘Social Security offset.’  Many people end up paying for nothing.”

The lawyer continued, “And remember, Denise, keep treating regularly.  Even with MS, Social Security assumes you are doing better if you aren’t verifying your symptoms from time to time with your doctors.  It’s unfair, but true.”

“Got it.  Mr. Kinney?”

“Andrew is fine.”

“Can you be my lawyer at the hearing?”  Denise felt better asking this.

“I’ll put your request in our computer system.  I do about 350 hearings a year.  It takes about two years and two appeals to get to a hearing.  When that time comes up, they will check if I am available.  It could be someone else here, but I trust them or I wouldn’t work with them.”

“Ok.”  The call ended.  Her body relaxed.  She felt someone was on her side.  She breathed out.  Two years?  Here we go.  Some weight on her shoulders lifted, and she felt less alone.  She took a nap.

 

That night, she had the same dream.  She was thrown into the lake.  This time, a hand reached down from above her head and grabbed her hand.  She woke up, scared and sweaty.

While she realized these nightmares weren’t true, the upcoming year would be her biggest test.

Chapter 3

The Referral.

 

Tuesday, April 5, 2011.  Office of Dr. James Strickland.  9 a.m.

Over the next few years of successive appointments, Denise got to know the staff at her neurologist’s office very well.  They all greeted her as she wound through to the examination room for her neurology appointments.  Emily, her primary nurse, had an experienced eye.  Her cousin, she once told her, had MS.

Emily got Denise through tough times, encouraging her to compete in this race without a line.

 

On this day, after a particularly tough week, Emily took Denise’s blood pressure and asked her an interesting question.  “You’re not working.  Have you applied for Social Security disability benefits?”

After a pause, Denise looked dejected.  “Yes, I did.  That was two years ago.  I was denied.”

“Did you appeal?”  Emily took off the cuff.

“No.  The government said no.”

Emily put her hands in Denise’s and looked into Denise’s eyes.  “Our patients tell me that everyone gets denied at first.  They told me they needed to appeal a few times and get a lawyer.”

“We can’t afford a lawyer.”  The sides of Denise’s mouth turned down as she formed the last word.  “We can barely afford our insurance.”

“Well, a couple of patients have told me about a firm that doesn’t charge unless you win.  A large one.  Right here in the cities.

Denise perked up.  “Do you know if I can apply again?”  Emily nodded no and handed her a piece of paper she grabbed from the examination room drawer.

“Ask them,” said Emily.  A law office name and phone number were on the piece of paper.  Were they on commercials?   “You never know, but I heard they are good.”

Denise thanked her and committed to calling the law fir6m that next day.  She slowly folded it up and tucked it into her back jean pocket.  Emily left the room.

Outside the examination room, a chart rattled against door.  A few minutes later, it opened.  “Good morning, Denise.  You are looking good today.”  Dr. Strickland entered rooms with efficiency.  His jet black hair was parted neatly and streaked with grey.

Sitting across from her, he said, “How are things going?”

“Well, about the same, doctor.  But my right arm is more clumsy now.  I can’t write letters worth reading.”  She laughed to herself.  “My writing looks like I drank a 12-pack.”  She looked up, embarrassed.  “I don’t drink, doctor.”

“I know.”  He nodded gently like an approving father.

“And my recent relapse made my fatigue worse, much worse than before.  Isn’t the medication working?”

Dr. Strickland took a measured breath.  “Yes, these injectable medication regimens can lose their efficacy over time.  We could consider changing it, but my patients have not noticed much short-time improvement doing so.”  He looked at her chart.  Your numbers don’t look too bad.”

“But I’m not feeling well.”  She swallowed hard.  “Doctor.  Do you think I can work?  I mean, do you think I am disabled.”   The question hung in the air.

“Well, Denise, you have relapsing-remitting MS.  You are showing the normal symptoms associated with it, including loss of coordination and fatigue.  Your vision does appear better.  Were you thinking of going back to work?”

“No.  I’m just too tired.  I’m applying for disability.”  Denise looked across at the examination table.  A new examination paper sat on top, drawn from a large supply roll of paper on the side.  It looked like a big roll of toilet paper.  The timing of the thought confused her.

“You certainly have followed our recommendations.  Your recent MRI confirmed the progression of the lesions.  Have you thought about sit-down work, maybe part-time?”

“Yes, I had one at the hospital.  My husband and I could really use the money.  But I’m not coordinated enough anymore to type, and I just cannot function in the afternoon.  I’m a klutz and I just get so tired.”

“Yes, that would be consistent with your objective findings.  I’ll tell you what.  I will perform some extra testing today to confirm how you are doing clinically.  One test reproduces fatigue.  I might not know if you could work at all, but a full-time schedule would seem out of the question at this point.”  He wrote down some notes.

Denise underwent a longer physical examination than normal, moving her arms and walking on her heels.  The tests made her feel tired and clumsy – more than ever before.  Her husband picked her up outside the clinic.  Looking through the car window, she worried about his job.  He takes a lot of time off for my appointments.

Her husband came out to her side of the car and helped her into their old fire red Buick.  Maybe, she thought to herself, I could make appointments late in the afternoon after school and Krissy could pick me up.  Her oldest daughter was a careful driver.  Denise planned to write that down.  Her memory was getting worse.

As her husband buckled his seat belt, she turned to him.  He was looking at her as if he had said something.  “What, honey. Did you say something?”  He nodded his head disapprovingly and started to drive.  Had he really said something?  She was too afraid to ask.

A few minutes later into the trip home, she told her husband about filing a new claim for Social Security disability.  He was quiet for a while.  He was not skeptical by nature, but he never got excited about what he could not see.

Then, with half-effort, he spoke.  “We lost before.  We need good help.”  He became quiet again.  He stared at the road, mouth unmoving.

Looking out the passenger window, she was lost in her thoughts.  The Buick’s engine droned.  To no one in particular, she whispered, “We do.”

She became nervous.  Will the law firm want to help me?  She soon found out.

Chapter 2

The Diagnosis.

 

Thursday, October 16, 2008. 

Office of Dr. James Strickland.  Neurology.  10:15 a.m.

 

“Well, Denise.  I looked at your MRI results.  You and your husband were worried about your coordination issues.”  In Dr. Strickland’s voice, still new to her, something was wrong.

They were sitting in Dr. Strickland’s office.  Happy faces looked out from family pictures on his walls and desk.  In the picture closest to Denise, the doctor smiled broadly, holding a big fish.

But now, in his office, the doctor’s 50’s-something face looked solemn, etched, and far away.  He brought out a color picture.  Her MRI, she thought.

He held up her MRI and touched it with his pen in the middle.  His voice became mechanical, clinical, as if he were reading instructions.  “This is the c-spine MRI we ordered.  I took a look at it earlier this morning.  The radiologist already interpreted it.”  His touched his pen to the MRI.  “This is your cervical spine.  This is your spinal cord.”  He drew in a short breath.  Denise shifted forward.

“See these spots here?”  He tapped his pen up and down the MRI.  “These are lesions on your cervical spinal cord.”

Her heart quickened.  Did he say lesions?  Denise thought.  Cancer?  She looked at her husband.  He was staring intently at the MRI, mouth slightly open.

“From what I can tell, these lesions are the early signs of multiple sclerosis.  The radiologist agrees.”  The doctor stared directly at Denise.  Denise was struck cold and motionless.

“What?  MS?”  Her voice failed her.  She half-whispered, “Are you sure?”

“Yes, Ms. Johnson.  These spots show demyelination in a pattern unique to MS.  We’ll do more testing.  We’ll definitely need a spinal tap.”  Did he say spinal tap?  “But the non-invasive testing we’ve done so far, such as coordination tests, support this diagnosis, too.”  He pointed to her side.  “Especially your right arm.”

He then placed a finger to his eyes.  “And your vision issues are associated with what’s called optic neuritis, a common MS symptom.”  He took a breath.  “I’m sorry.”  The words lingered like black ribbons in the air.  No smiles.  No vacation.  Nothing happy.  Darkness around me.

Denise stared back and forth blankly at the two men.  They looked at her and said nothing.  She spoke to the ceiling light.  “MS?  How could I get MS?”  Then she looked at the doctor.  “Can it go away?  Can I take medications?”

“MS, once confirmed, is not curable.  We can stall it, sometimes for years, but it gradually becomes more symptomatic.  The medications, if covered, do have side-effects.”  The rest of the appointment, questions about insurance, medications, treatment, and other particulars were swept away in her private, spinning tunnel.  MS?  She felt so alone.  Am I going to die?  Hands on her face under her veil of long brown curly hair, she quietly sobbed.  Her head shook slightly, uncontrollably.  Trapped.

Hands touched her forearms.  Warm, muffled words came in assuring tones.  More apologies.  Appointment over.  Her husband and nurse guided her out.  Aseptic smells of rubbing alcohol wafted in and out.  Strange, sad eyes tracked her through the waiting room.  The car ride home was numb and quiet.  She sat at the kitchen table.

Soon, she took a fitful nap.  She awakened later and looked out her bedroom window.  Dusk.  She heard her girls murmuring outside the bedroom door.  “Mom needs time,” her husband quietly told them.  The sounds of voices trailed away.  Her cheeks were tight with dried tears.

Alone with MS.  So alone.

In the long nights that followed those days, Denise had dreams of when she was a child.  It was summer at the cabin.  She was at the lakeshore at an isolated swimming hole.  It was mid-afternoon.  Bright sunlight danced overhead.  A warm breeze brushed her arms.  Broad groups of white clouds hung tightly against the bright blue sky.

In one quick movement, her boy cousins grabbed her by the arms and legs and threw her into the lake.  They were laughing.  She couldn’t swim.

The rush of cold water made her small, 5-year-old heart pound.  Her arms and legs, flaying in panic, scrambled for mooring.  Her feet stepped up an invisible ladder.  She turned her body toward shore and went deeper underwater.  She breathed in water.  Bubbles surrounding her offered no air.  Her cousins yelled for her.  Parts of her name registered deep within her.  Flits of light and brown cedar water rushed above her head.

Then Denise would wake up, scared and sweating.

 

A few months into her diagnosis, work proved more difficult.  Coworkers stopped talking when she walked by, looking like they felt guilty to be happy.  She made more mistakes, including a few brushes with missed deadlines.  Her close friends helped her complete reports, while those less close to her became less friendly.  Sick days came more often, often without warning.  Denise was falling behind.

One night in bed, her husband turned on his bedside light, sat up, and looked at her sternly.  “The doctor told us that stress is makin’ your MS worse, and you just aren’t the same.  I don’t want that freakin’ hospital stealin’ your health from you.  It’s not worth it.”

Surprised but tired, Denise answered, “What about money?  Don’t we need my income?”

“Maybe I’ll become shift supervisor.”  He said it, but his voice betrayed him.  His factory job was the best he could get in their small Minnesota town, but hard work was only rewarded with more work.  “We’ll save more.”  They already cut expenses.  A lot.  He added, “The girls could use you at home after school.  And you could do things around the house when you are up to it.”  Neither knew what she would be “up” to doing.  Neither asked.

At least his job gave them medical insurance.  But the lean cords of survival tightened.  And despite cutting expenses, they juggled surges of bills, calling for more time on late ones.  Savings were meager.  Their two daughters were in high school.  College was a dark cloud overhead that no one dared to look up and see.

With Denise and her husband committed to her staying home, Denise went to her appointments, took Rebif injections, had good periods, and suffered through difficult relapses.  She learned how to moderate her activity, planning errands over different days.  She did chores as she could, getting help when she could get it.

Her relapses, however, stole more coordination – bit by bit – each round.

Her husband got overtime hours when he could.  Her daughters pitched in around the house, sometimes making dinner.  Denise thought they were good kids, but they were too young for the weight they carried.  This, in turn, weighed on her.

Mundane errands became walls.  Grocery shopping was impossible for her to do alone.  Her close friends called and visited.  But some days, she didn’t want to answer the phone.  She sat alone at the kitchen table.  She was tired and stressed.  Life for her became cold coffee that she had to swallow.

In the darker afternoons of the shorter winter days, she sat at the table and cried.

Fatigue, a frequent intruder, stole her energy and lurked behind her every movement.  Her eyes felt heavy.

But help was coming.

A Legal Story

[The following chapters are part of a series that explains what happens before, during, and after a Social Security hearing from an experienced Social Security benefits attorney.  Client names and particular fact patterns were changed to protect confidentiality.]

Prelude

Monday, June 3, 2013.  Johnson’s House.  Mid-afternoon.

Sitting alone at her kitchen table, Denise was worried.  A rhythm of raindrops caressed the window screen.  Fall colors filtered through the window, casting stained glass shapes onto the tile floor.

What would her Social Security hearing be like?  What could she say to a judge?  She’d been out of work so long.  “Five years?” she muttered to herself.  And now, for two years, she’d worried about her Social Security hearing.  It was next week.

Her soft brown eyes reddened.  It was about all she could bear.  What if she lost?  Will we lose the house?

With her unsteady left hand, she took a small sip of coffee.  She choked as it went down the wrong way.

Chapter 1

The Mug

October, 2008. 

It was a rainy Monday morning.  Green was giving way to orange and yellow on the leaves of the trees.  Denise did not mind her part-time accounts receivable job in the billing department of the county hospital.  Although it was repetitive, it brought home money to pay the expanding bills while the girls were in school.

She rubbed and squinted her eyes.  The columns of numbers on her computer monitor were blurry.  She never wore glasses, she thought.  Are my eyes going?  She felt dizzy.  The flu?   She felt her head.  No temperature.  She looked around.  Her friends were at work, their glazed eyes fixed to computer monitors.  Each were bored but busy in their pale gray fabric work cubicles.

She was tired.  Dead tired.  She looked up at the hallway clock.  Just past 10 a.m.  Only 10?  She heard the red second hand ticking.

And she was weak, more on her right side than her left.  She lifted up her right arm and turned her palm up toward her.  Maybe she had overdone it yesterday.  She mentally went through a checklist of her activities the day before.  X’s on her pinned-up calendar announced days already past.  Yes, yesterday was Sunday.  It’s only Monday?  Why does it feel like later in the week?  Her weakness was different, as if it came from the inside.

Had I eaten breakfast?  She felt a little nauseous.  The coffee in her yellow smiling face mug was cold and half-empty.  She looked at it.  Today, its smile mocked her.

I’ve been clumsy these days, too.  She looked under her desk at her right foot.  She had taken off her right shoe once she got to work.  In the shower, she noticed her right little toe was black and swollen from jamming it into a kitchen chair the day before.

Man, that throbs.  I hope I didn’t break it, she thought.  Maybe I could get an x-ray during lunch from Joe in radiology.  She winced, held her breath, and carefully wiggled her toe.

A half hour later, she felt a strong wave of nausea and odd crawling sensations in her right arm.

She questioned herself again.  Did I get enough sleep?  Her boss had been pressing her department to work faster.  She looked at her right hand.  Carpal tunnel?  Her friend Sandy had that last year.  She bent her right wrist inward.  I don’t want to have release surgery like she had.

A peculiar tingling sensation went through her body, like a hot, itchy electric wire was turned on and was fed down into her right arm.  Her body, in some way, wasn’t hers.  What the hell did I do? 

The second hand ticked more.

 

The next morning, Denise made coffee for her and her husband.  Clumsy movements.  Jamming fingers.  Nausea.  Sore right toe.  Electric jolts shot into her right arm.  She spilled coffee grinds on the counter past the coffee filter.  “Damn,” she muttered under her breath.

When the brew cycle completed, she poured a cup of black coffee for her husband.  With her right hand, she extended it to him.  His ceramic mug paused in the air between them.  He looked at her funny, catching her glance before they both looked at her right hand.

Something was different.  Time slowed down.

Sensing her right arm was weak, she tried to strengthen her grip.   No response.  Their bridge of arms collapsed between them.  In slow motion, she watched her right hand loosen.  The mug came out.  She couldn’t react, just watch.  With a loud crash, pieces of ceramic and black coffee splattered across the tile floor.  Circles of steam rose up and encircled their feet.

That morning, her right arm was not hers.  And she was tired, so tired.  Denise needed to find out what was wrong.  Soon, she would.

According to the Mayo Clinic, Hidradenitis Suppurativa (HS) is chronic inflammation and deep lesions of the skin, particularly in sensitive areas of the armpits and groin.  Possible causes are thought to involve a combination of genetics, hormones, and other factors.  HS may impact 1-2% of the population, but absolute numbers are uncertain.

Given how relatively rare this medical condition is, our attorneys at Hoglund Law Offices have successfully represented a surprising number of clients with Hidradenitis Suppurativa in Social Security Disability benefits claims.  Our clients have typically worked for over ten years or more with symptoms before succumbing to the progressive lesions and pain despite surgical intervention.

How does Social Security Disability evaluate Hidradenitis Suppurativa?  Social Security verifies the diagnosis first.  In my experience, records usually carry ongoing primary care treatment for recurring boils that require in-office lancing.  Of concern, I have seen some medical record histories that initially fail to specifically diagnose HS until these lesions have persisted in various forms and locations for a few years.  There are possible reasons for this that I address below.

Social Security reviews Hidradenitis Suppurativa claims under a special definition of disability called a listing.  Here is the “listing” that Social Security applies to claims based on Hidradenitis Suppurativa:

Listing 8.06

Hidradenitis suppurativa, with extensive skin lesions involving both axillae, both inguinal areas or the perineum that persist for at least 3 months despite continuing treatment as prescribed.

How do our Social Security disability attorneys at Hoglund Law Offices get approvals at Social Security hearings for clients with Hidradenitis Suppurativa?  In our experience, the timing of the diagnosis may be an issue.  I argue to judges that the nature of the HS lesions may not, in themselves, manifest themselves to physicians initially – particularly if my clients see different primary care physicians from appointment to appointment or change facilities from time to time.  Over time, however, the diagnosis of HS should relate back to previous care for the symptoms.  Our attorneys can offer advice to get retrospective input from these physicians.

Deficiencies in the medical evidence of HS may relate to the location of the lesions.  My clients may attempt to suffer through a period of HS lesions in private areas of their bodies.  Despite the Social Security Administration’s assumptions, it is not always easy to seek care for personally sensitive problems.  I argue to judges that a delay in diagnosis, in these instances, has more to do with social factors.  Reporting the full constellation of symptoms right away has been difficult for some of my clients.

What should your Social Security Disability attorney know about Hidradenitis Suppurativa?  In my experience, it is common to have judges and medical experts who are unfamiliar with HD.  I understand that Social Security judges must review many kinds of medical claims.  I speculate that medical experts (ME’s) at hearings, however, may not be as familiar (and miss) Hidradenitis Suppurativa because it is a dermatological condition that may not normally arise in other specialty areas.

What must your Social Security disability attorney do at your Social Security hearing?  He or she must raise the issue of Listing 8.06 and point out the diagnosis, duration, location, impact, and daily care duties that impede full-time employment.  Additional legal documentation has proven helpful in our clients’ claims.  Call us at Hoglund Law Offices today if you are interested in the experience our Social Security attorneys can offer you to apply or appeal your Social Security Disability claim.

Andrew Kinney, Esq.