A Practical Approach To Your Disability Claims by J. Ernest Harr, Columbia, S.C. J. Ernest Harr, Attorney at Law, formerly served on the Social Security Staff and as a Trial Attorney for the Government Representation Project. The Social Security Act and its regulations define disability for purposes of entitlement to disability benefits. This definition requires that you experience a physical or mental impairment or combination of such impairments which have lasted or can be expected to last for at least 12 months. In addition, the impairments or combination of impairments must be totally disabling. This means that your residual capacity (what you can still do physically and mentally despite your condition) is such that you cannot perform any past relevant work done in the preceding 15 years or successfully adjust to other occupations which would be less physically or mentally demanding. When considering the above definition, you should keep in mind that the successful performance of a job in the world of work requires two basic capacities. These are the ability to sustain the physical requirements of work (strength related or postural requirements) and the ability to sustain the mental requirements of attentiveness, alertness, and concentration until the work activity is completed. The level of mentation required will also depend upon the skill level of the job, skilled jobs requiring a higher level of concentration than required of semi-skilled or unskilled work. In applying the definition in the adjudication of disability claims, the Social Security Administration (SSA) has developed a five step process. Many readers will have some familiarity with this process which is known as the sequential evaluation: (l) Is the claimant working? (2) Is there a severe impairment: (3) Does the impairment meet or equal a listing: (4) Does the individual retain the capacity for past relevant work: and (5) Does the individual retain the capacity to adjust to a significant number of alternative jobs: The first step in the above evaluation is a screening step which results in a denial for those individuals who are currently demonstrating work activity which is considered "substantial, gainful activity." Step two requires that an individual document that he or she experiences an impairment or combination of impairments which are "severe." This is a determination that the above impairment(s) results in a limitation of functions in one or more basic work activities. Examples of such basic work activities include standing, walking, lifting, bending, sitting, manipulative functions, seeing, talking, hearing and the ability to concentrate and use judgment. 9 Assuming that an individual has demonstrated the presence of a severe impairment, the focus will then go to step three which considers whether there exists medical findings (signs, symptoms, and clinical or laboratory test data) which meet or are equivalent to a listed impairment found in one of 13 Listing Categories. Please note that CFIDS is currently not a listed impairment. If the individual does not have an impairment(s) which meets or equals a listing, the issue then becomes one of residual capacity. At step four, the issue is whether the individual can perform any former work done during the preceding 15 years. If the individual's impairment(s) prevent such past relevant work, the focus then moves to step five which considers whether the individual retains the residual capacity to adjust to a significant number of less physically or mentally demanding jobs. It is at step five that the SSA uses a system of grids which focus on maximum sustained strength capacities and various combinations of age, education and past relevant work. The grids contain rules which direct findings of disabled or not disabled. The grids do not control this determination if non-exertional impairments (conditions not related to physical strength, i.e. lifting, standing, walking) are present. Examples of such non-exertional limitations are depression, mental fatigue, impaired concentration, manipulative impairments of the hands, feet, and postural limitations. It is my firm belief that in the majority of cases involving CFIDS, the focus will be on whether the individual retains the capacity at "step five" to perform the minimum requirements of sedentary unskilled work activity. In practice, this is the lowest level of competitive work recognized by SSA. I believe that the questions below can be useful in developing CFIDS cases. Indeed, the representatives of CFIDS claimants may wish to present similar questions to the respective treating physicians for comment which c. n then be presented as medical evidence in the Social Security claim. It may also prove useful for the CFIDS sufferer to maintain a short concise diary which plots the c course of his/her illness and symptoms. He/she may wish to present this diary to his/her physician and request his opinion as to the credibility of the illness and symptoms reflected therein based upon his own observations and findings as a treating physician. Again, where symptoms are alleged, I believe it is important to have a treating physician indicate that the medical illness could reasonably cause the reported complaints, if he is so inclined based upon his own medical findings. Suggested CFIDS medical development questions and opinions > Ask the treating physician to state the medical conditions for which you have been under treatment. (It is helpful to have your physician state as many positive signs and test data which support the diagnosis as possible.) >Ask the treating physician to indicate the type of treatment received and your response to date > State the symptoms which you are actually experiencing and request an opinion from your treating physician as to whether his/her own medical findings indicate the presence of a condition which could reasonably cause the symptoms alleged. An individual with CFIDS may experience many symptoms. I have compiled from my own research, a list which is not totally inclusive: fatigue, chills, anxiety, fever, stomach pains, mood swings, headaches, sleep disorders weight loss, sore throat night sweats, swollen glands, urinary discomfort joint pains, impaired coordination, muscle aches, slurred speech, heat sensitivity, extremity swelling cold sensitivity, mental confusion, light sensitivity, impaired concentration nausea and depression. >Request an opinion from your physician as to your residual capacity to sustain the postural requirements of sitting and the strength requirements of standing and walking during an eight hour period found at most competitive jobs. > Request an opinion as to any impairment related to repetitive use of the hands, arms, legs or feet as a result of your conditions based upon medical finding. > Request an opinion as to your limitations, if any, in lifting, based upon medical Findings. > Request an opinion based upon medical findings as to whether your condition could be expected to limit attentiveness, alertness, or concentration in a work-like setting as compared to a similar but unimpaired individual. > Request an opinion as to how the physician believes that you would react to the physical and mental demands of a job schedule or job stresses. > Request an opinion based upon medical findings as to whether you are currently capable of performing the limited physical demands and mental demands of an unskilled sedentary job eight hours a day, five days a week. The above article was reproduced through the courtesy of, and with the permission of: The CFIDS Association P.O. Box 220398 Charlotte, NC 28222-0398 704-362-2343 Basic membership in the CFIDS Association is $25.00 per year, and includes a subscription to the Chronicle, the quarterly journal of the Association. Additional contributions go directly to fund additional research and advocacy efforts. The CFIDS Chronicle serves as a clearing house for information about chronic fatigue and immune dysfunction syndrome (CFIDS) also known as Chronic Fatigue Syndrome (CFS) and Chronic Epstein-Barr virus (CEBV). The ideas expressed by each columnist are strictly his/her own. Some of the information contained herein is intended to help persons with CFIDS (PWCs) make informed decisions about their health. However, the CFIDS Association, Inc., and THE CFIDS CHRONICLE do not dispense medical advice or endorse any specific medical hypothesis or product and assume no reponsibility for any treatment undertaken by readers of this journal. IMMMMMMMMMMMMMMMMMMMMMMMMMMMM; : This file came from : IMMMMMMMMMMMMMMMMMJMMMMMMMMMMMMMMMMMMMMMMMMMMMMJMMMMMMMMMMMMMMMMMMM; : Wholenote BBS, Asheville, NC (704) 251-9863 : : Information on Chronic Fatigue Syndrome, Friedreich's Ataxia, : : support groups, and whatever other miscellanea I can find! : : Give us a call sometime at (704) 251-9863 : : Will McGuffin - sysop J. David Kiser - co sysop : HMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM<