Caution !!! I was retired by "Uncle" from a civil service position and  have
ended up financially devistated .... After 18 years,  I recieve a whopping
retirement that is less than $200.00 per month -  Social security disability
is not a sure thing either ! Remember that  the  government will  subtract
your retirement  check from the amount that the feel you are due from Social
Security ! You Do Not Get BOTH even though you have paid into both !!! Be
sure you  find out  if you can afford to  be retired in this manner ....
Also it was 6 months before  Social Security kicked in for me. I recieved 24
hours notice when I was  medically retired. I had no way to plan for
expenses that I had out on credit cards or a new piece of equipment that my
wife had purchased for her  ranch.  Make sure you  know your options !!!!

Here is some important information that you need to consider !

What Parkinsonians Should Know About Social Security Disability
This is a report that was published in the Southern Medical Journal
1995;88,3:256-259 March 1995.
It is of significant importance to Parkinson's families, care-givers and
their doctors. The point that this Dis-Ease becomes a disability is
determined by the patient.
For the "working Parkie or ET", you may discover that you can't make it to
retirement or until the kids are out of school. Your care-giver may see that
trying to continue on, is dangerous in your condition.
Dr. Scovern's work takes some of the mystery out of the application for
Social Security Disability. It stresses the point that your physician needs
to keep a record of your diagnosis and treatment, relating how the
progression of the different symptoms effect your ability to work. He gives
examples. Look them over and start relating your symptoms with your doctor
and their impact on WORK-RELATED activities.
UPDRS and ADL over the duration supports your case.
Many Physicians, are still in the "dark" like Dr. Scovern was before he
became involved in Social Security, about what kind of information was
really needed. Print a copy of this paper for each of your doctors.
-----------------Start of Report-------------------
Social Security Disability: Guidelines for Medical Practitioners
HENRY SCOVERN, MD, Philadelphia, Pa
ABSTRACT: The purpose of this paper is to introduce medical practitioners to
the concepts and function of the Social Security Administration's process of
awarding disability benefits. Better understanding of this massive and
important program will enable physicians to focus on and present appropriate
information. This will facilitate processing of applications to the benefit
of physicians, patients, and society.
The Social Security Administration of the Department of Health and Human
Services (HHS) received 3,611,377 applications for disability benefits
during fiscal year 1994 and expects as many as 3.9 million applications in
fiscal year 1995. In processing applications, the SSA requests medical
information from practitioners of all specialties. Unfortunately for
practicing physicians, this branch of government and its mode of function
can seem like a "black box." Few if any medical schools and postgraduate
programs devote time to disability issues in general or to Social Security
disability in particular. Because of this lack of understanding,
considerable physician time is wasted in providing information that does not
further the evaluation of disability, and physicians can become frustrated
with the system. Before becoming involved as a medical case reviewer, I was
mystified by the process of Social Security disability and was upset and
confused about requests for information and about the results I saw. At
times it seemed that the applications of patients who were severely
incapacitated were arbitrarily denied, while those of individuals with vague
complaints were allowed. In my current capacity learned that the system is
rational, though at times cumbersome, and is largely codified by law,
judicial review, and structured policy-making procedure.
This paper is an attempt to introduce physicians who care for adult patients
with medical and surgical illness to the salient aspects of the Social
Security Administration's disability evaluation process. Although there are
similarities, the SSA's approach to the medical evaluation of disability in
children and patients with psychiatric illness is significantly different
and is not addressed in this paper.
BACKGROUND INFORMATION
There are two broad Social Security disability programs (Table 1). Title II,
or Social Security Disability Insurance (SSDI), may be regarded as a
contract between the government and a participating worker. It covers
individuals who have engaged in meaningful work activity but are no longer
able to work because of a medical condition. It is analogous to an insurance
policy that is earned by engaging in work activity and is financed through
the Social Security tax. Title XVI, or the Supplemental Security Income
program {SSI), replaced separate state programs for needy persons and is
financed and administered by the federal government through general
revenues. There is no qualifying work requirement, but there is a limit on
the amount of income and resources that a person can have and still be
eligible. From the medical evaluation standpoint, the programs are treated
identically.
TABLE 1. Administrative Terms
-----------------------------------------------------------
HHS = Department of Health and Human Services
SSA = Social Security Administration, an agency within HHS
SSDI = Social Security Disability Insurance, a Social Security disability
insurance program; eligibility is earned through work
SSI = Supplemental Security Income, a Social Security disability program
administered as an entitlement
-----------------------------------------------------------
THE APPLICATION EVALUATION PROCESS -
SSA Definition of Disability
According to law, medical factors that might contribute to disability must
be evaluated to determine whether the applicant has an impairment that is
severe enough to have more than a minimal impact on work-related activity
(Table 2) and:
(a) is listed in the Listing of Impairments* or is equiv-alent in severity;
or
(b) prevents the individual from engaging in a previous occupation and the
individual's physical and/or mental capacities, age, education, and
vocational experience do not permit adjustment to work different from that
performed in the past. To he considered disabled under this mechanism, the
individual must he unable to perform any job in the national economy for
which he is qualified. Specialized examiners use publications such a the
Dictionary of Occupational Titles to determine the physical demands for
various job titles.
To be considered disabling under Social Security law, a condition must be
expected to last 12 months or to result in death.
ONSET In the SSDI program, "onset" (ie, when disability began) can be
retroactive. In other words, the disabled individual may be eligible to
receive benefits for a period of time before he actually filed the claim.
Therefore, if the SSDI applicant is deemed disabled, onset becomes an
important consideration.
----------------------------------------------------------
The Listing of Impairments for Adults has been extensively updated recently.
Therefore the SSA is now preparing a revised handbook for physicians. It is
scheduled for release during the fall of 1994. To receive a copy of the
publication, which is entitled "Disability Evaluation under Social
Security," contact the SSA 0ffice of Disability at (410) 965-7673.
Availability by Internet is also planned.
----------------------------------------------------------
TABLE 2. Operational Terms
----------------------------------------------------------
Medical Listings
The Listing of Impairments, which is organized by body system, enumerates
conditions which are considered by SSA to cause severe impairment of
physical and mental function. It is used by Social Security to gauge the
work-related severity of an applicant's condition. If an applicant's
condition meets the requirements of the Listing or is equal in severity,
from a medical standpoint disability is assumed. If an applicant has a
severe condition short of the conditions stated in the Listings, further
assessment of RFC, background, training and education is required for
adjudication of the claim.
0nset
The time at which limitation of work-related function became significant
enough to result in a finding of disability, according to SSA regulations.
Severity
A determination of whether and to what degree a condition limits an
individual's physical or mental capacity to perform basic work activities.
RFC
Residual Functional Capacity-an assessment of the remaining capacity for
work-related function.
-----------------------------------------------------------
SEVERITY AND RESIDUAL FUNCTIONAL CAPACITY.
To determine the severity of the applicant's medical condition ("severity")
and the remaining capacity for work-related function ("residual functional
capacity" [RFC]), review of medical records is undertaken by trained lay
individuals and physicians who are employed by or who contract with SSA.
Sufficient objective data must be obtained so as to enable the SSA reviewer
to independently assess severity and RFC. Existing data provided by treating
physicians is given the most weight as it offers the benefits of personal
and longitudinal observation. However, if the treating source material is
inadequate, then additional information must be obtained from a purchased
"consultative examination" directed toward the applicant's alleged
complaints.
CONSULTATIVE EXAMINATIONS.
Treating physicians are encouraged to provide these consultative
examinations. If the treating physician can not or is not qualified to
perform the specialized examination, it is purchased from one of a panel of
local physicians. Usually the physician performing the consultative
examination is given a list of specific questions to be addressed (in
addition to obtaining any other relevant historical and physical findings).
The role of the examining physician is to identify relevant historical and
physical examination findings and submit a detailed report pertaining to any
condition that could affect the applicant's ability to function in the work
place. Conclusions regarding specific capabilities should be buttressed by
the objective data.
POSTEVALUATION PROCEDURE.
If medical factors support the applicant's contention of disability, an
administrative eligibility evaluation takes place. For instance, to be
awarded benefits, the applicant must not be engaged in work activity that
provides substantial remuneration. In the absence of adverse administrative
factors, benefits are then awarded. If consideration of the medical and
administrative factors leads to denial of the application, a sequential
appeals process is available. The applicant may ask for reconsideration of
the same evidence or may furnish supplementary evidence. If the application
is again unsuccessful at the reconsideration level, it may be appealed
further to an administrative law judge. Applicants may retain an attorney at
any phase of the process. Fees are billed at an hourly rate but are payable
only on a contingency basis. In certain allowed claims situations, attorney
fees may be deducted from benefits that have previously accrued, not to
exceed 25% of the past due benefits.
----------------------------------------------------------
TABLE 3. Principles of Effective Patient Data Reporting for Social Security
Disability Purposes
----------------------------------------------------------
Report disease process(es), with particular emphasis on objective findings
with work-related, functional impact.
Report the time course of the functional consequences in terms of their
first appearance and expected duration.
Support statements with objective findings through physical examination
findings and radiologic, laboratory, and hospital records.
Subjective complaints (eg, pain, fatigue, etc) must be consistent with the
stage of the disease process and the objective findings.
Copies of longitudinal office notes are best, if they are legible and the
essential information is present.
----------------------------------------------------------
ROLE OF THE TREATING PHYSICIAN
Medical information is requested from all sources identified by the
applicant. Ordinarily, the treating physician(s) is most aware of the
applicant's history and current functional status, and information so,
provided is given emphasis. Unfortunately, much of what is received from
hospitals and treating physicians is not suitable for evaluation of
disability, because it either lacks information relevant to the applicant's
ability to perform work-related activity or it is too subjective.
Unsupported statements such as 'This applicant is disabled" are frequently
received, but do little to further the evaluation of the claim.
Alternatively, the medical records may sufficiently clarify the present
situation but fail to support retroactive benefits because of inadequate
longitudinal record keeping. Specialized knowledge of the physical
capabilities required for work is beyond the scope of most medical activity.
Sometimes one can appreciate these concepts intuitively, eg, that good
function of the hands and shoulders and intact ability to stoop, lift, and
carry would be very important to an individual without other training who
had spent a 20-year career exclusively in the construction trades. However,
the treating physician is not expected to have such knowledge, nor to
provide conclusions about disability. Instead, the essential role (Table 3)
is to provide objective medical documentation along with dates to enable
Social Security personnel to independently determine severity, RFC, and
onset according to Social Security regulations. If the physician feels
capable, his assessment of the applicant's remaining physical/mental
capacity, which is consistent with the objective medical evidence, should
also be provided. Subjective factors (eg, pain) and historical statements
about daily functioning should be supported by the reported objective
findings. Relevant radiologic and laboratory data should be forwarded, and
any circumstances that compound the applicant's situation should be
presented.
EMPHASIS ON FUNCTIONAL ASSESSMENT
In contrast to most of medicine in which the physician evaluates the
progress of a disease, dysfunction (regarding work-related activity) is the
primary focus of disability evaluation. Therefore, findings should be
reported in terms of the mechanisms by which the disease(s) causes
work-related dysfunction and should be consistent with the stage of the
applicant's disease process. Several examples follow for illustrative
purposes. If an individual suffered arthritis, the musculoskeletal
examination would be key. Relevant information would include range of
motion, evidence of inflammation or deformity, ability to maneuver for the
examination (dress undress, change positions on the examination table, etc),
fine motor function (writing, picking up coins, buttoning clothes, etc), and
gross motor function (gait, grip strength, formal muscle strength testing,
etc). Similar clinical information would be needed for an individual with a
hemiparesis. Emphasis would be placed on gait, need for an ambulatory
assistive device, fine and gross motor function, and communicative or visual
dysfunction. For an individual with emphysema respiratory rate, use of
accessory muscles signs of respiratory difficulty during the examination,
diminished breath sounds, cyanosis; signs of heart failure, history of
repeated hospitalization, need for supplemental oxygen, findings on chest
films, arterial blood gas values, and results of pulmonary function studies
would facilitate evaluation. Ischemic heart disease would be supported by
complaints suggestive of angina or congestive heart failure, results of
invasive and non-invasive cardiac testing, physical findings of congestive
heart failure, and documentation of myocardial infarction. Many diseases
(AIDS, inflammatory bowel disease, cancer, systemic vasculitis, systemic
lupus, etc) can cause dysfunction on the basis of multifocal involvement or
on the basis of generalized debility, weight loss, need for repeated
operative procedures, and secondary complications. Evaluation requires
accurate information on the clinical process and the time course of its
progression. The Medical Listings are organized by body system and provide
the framework for the Social Security medical evaluation process. Discussion
of each impairment, according to Listing, is beyond the scope of this paper.
However, physicians can use the Medical Listings and the accompanying
explanations as a guide to parameters Social Security uses to gauge
severity. Following an initial adaptation period and learning curve, it soon
becomes routine to incorporate critical information related to potential
disability into the interview, examination, and progress notes. If such
information were consistently provided to the Social Security
Administration, the efficiency and effectiveness of the disability
evaluation process would be greatly enhanced, to everyone's benefit.


----- Original Message -----
From: Patricia Lewis <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, March 24, 2001 8:01 PM
Subject: GO FOR IT GEORGE


> See my answers below - from Burdette E. Anderson
> PD/17 yrs/onset 35/now 51.9
>
> I need some advice.
>
> I am in a demanding and responsible position in a fairly large company
that
> is going through reorganization and downsizing.  My company has a program
> that gives those on disability a monthly income.  I feel that my work is
not
> as good as it was in the past and I have to work longer hours and harder
to
> do my job.  The progression of my PD is slow.  I have been able to hide my
PD
> so far, but some days it is difficult. I have been asking myself, "What
> should I do to assure that I have an income in the future?" How can I
> determine when it is bad enough to apply for disability?"
>
> I hope that I can gain from the insights and wisdom of those on this list.
> >From what I have seen, there are some insightful people on this list who
are
> willing to share their experiences.
>
> 1.  Are there steps to take in any order to get on disability?
> First step: Get a letter from your neurologist verifying date of first
onset.  Apply for Social Security at your local Social Security office.  Go
in and say "I want to apply for SS Disability".  Not the Social Security
supplemental - you want the full blown disability.  Social Security may send
you to their own doctor for confirmation.  This is just a formality.  Don't
be afraid of this process.
> 2.  Are there any legal rights I might have? Or should be aware of?
> Of course you do - you have rights to disability from Social Security.
Parkinsons is disabiling.
> 3.  Do I need to go on record as having PD before I find that my job could
be
> eliminated?
> Absolutely, very important.  Don't hide this.  Establish the onset date
and the difficulties you are having at work.  Document, document, document.
> 4.  Was it hard to justify that you could not do any job? Could they ask
me
> to be a receptionist or guard or any easy-to-do job instead of going on
> disability?
> No, they cannot ask you to do something you are not trained or qualified
for, nor can they ask you to take lesser pay just because you are disabled.
Look for a Disabled Persons Advocate in your area.  Check phone book etc.
> 5.  Did you have to build up a case with your doctor as to what you could
do?
> No - you are disabled.  And you are entitled to disability benefits from
Social Security.  Should your company be so generous to have a supplemental
plan - great.  Go for it.  Then if you want to try to find something to keep
you busy - go volunteer or get a job doing something you can physically
handle.  You may loose $1 for every $2 or $3 you get from Social Security -
but remember that it is important to be active, productive and
self-satisfied.
>
>
> Personally, I was diagnosed with PD in 1985.  I continued to work until
1994.  Then moved to Montana and my wife and I are self-employed (in other
words: no wage!).  I applied for Social Security Disability in 1995.  They
sent me to a confirming neurologist, I was granted the disability, plus some
back pay!  Then my union kicked in with full disability payments.  We are
very lucky.  I continue to help around the business, nap alot, take no wage,
and get about $2400 per month.
>
> I have not gone to the Personal Department because I am not sure how fast
the
> word regarding my condition would spread and what impact it would have on
me.
> Confidential information here!  This should not spread unless you spread
it.  Legal action here I would think, if this happens beyond your control.
Again, start with your doctor.  But act before you get downsized.
>
>
> Good luck!  Would like to hear how you do with this!
> I really hope that some of you could respond.
>
> Looking forward to your insight.
>
> Best Regards,
>
> George
>
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>
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