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Your Doctor and the Social Security Listings

Summer 2010

Treating physicians often try to advance their patients' claims for Social Security Disability benefits. While Social Security will want a complete copy of the physician's medical records, office notes are often abbreviated and sometimes difficult to read. Some physicians will draft a letter to advance the case of disability. Unfortunately, too many letters are not as helpful as they could be.

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Many letters simply consist of a statement from the physician that he or she considers you to be disabled. That will not help your claim at all. Social Security has a specific definition of disability that must be met in order to qualify for benefits, so rather than have the doctor's opinion about disability, they want to see -- from the medical record -- what symptoms and treatment were present that led to that conclusion.

A better letter from your physician would include:

  • A history of your symptoms and treatment;
  • Referrals to specialists and their results:
  • Any objective results of tests that support symptoms;
  • Relate any reported subjective symptoms to being typical for the diagnosis;
  • Clinical observations of symptoms or results of symptoms; and,
  • A listing of the restrictions and limitations on your activities and abilities that the physician recommends.
  • In addition, the letter would also note any of the Social Security listings and document the medical evidence that supports the listings.

    Social Security listings are found in a book published by Social Security called Disability Evaluation Under Social Security. This book contains a listing of impairments which describes, by medical condition, the severity level required to be considered disabled under any of Social Security's disability programs including SSDI and SSI, as well as Medi-Cal (Medicaid). The current listings for all immune system disorders for adults, including HIV/AIDS were revised and published in October 2008 (www.ssa.gov/disability/professionals/bluebook/14.00-Immune-Adult.htm).

    The listing of impairments is designed to help the state offices contracted to determine disability eligibility. In addition to listing severity levels of medical conditions, it provides information on how medical files should be documented for various medical conditions.

    According to Social Security rules, if your medical records show that your medical condition and its symptoms meet or equal one of the listings, you are to be considered disabled for Social Security purposes. People applying for disability benefits are well advised to rely on the listings and make sure their physicians have a copy of them.

    The current listing for 14.08 Human immunodeficiency virus (HIV) infection with documentation as described in 14.00F and one of the following:

    1. Bacterial infections:
      1. Mycobacterial infection (for example, caused by M. avium intracellulare, M. kansasii, or M. tuberculosis) at site other than the lungs, skin, or cervical or hilar lymph nodes, or pulmonary tuberculosis resistant to treatment; or
      2. Nocardiosis; or
      3. Salmonella bacteremia, recurrent non typhoid; or
      4. Multiple or recurrent bacterial infections, including pelvic inflammatory disease, requiring hospitalization or intravenous antibiotic treatment three or more times in a 12-month period.
      -- or --
    2. Fungal infections:
      1. Aspergillosis; or
      2. Candidiasis involving the esophagus, trachea, bronchi, or lungs, or at a site other than the skin, urinary tract, intestinal tract, or oral or vulvovaginal mucous membranes; or
      3. Coccidioidomycosis, at a site other than the lungs or lymph nodes; or
      4. Cryptococcosis, at a site other than the lungs (for example, cryptococcal meningitis); or
      5. Histoplasmosis, at a site other than the lungs or lymph nodes; or
      6. Mucormycosis; or
      7. Pneumocystis pneumonia or extrapulmonary Pneumocystis infection.
      -- or --
    3. Protozoan or helminthic infections:
      1. Cryptosporidiosis, isosporiasis, or microsporidiosis, with diarrhea lasting for 1 month or longer; or
      2. Strongyloidiasis, extra intestinal; or
      3. Toxoplasmosis of an organ other than the liver, spleen, or lymph nodes.
      -- or --
    4. Viral infections:
      1. Cytomegalovirus disease (documented as described in 14.00F3b(ii)) at a site other than the liver, spleen, or lymph nodes; or
      2. Herpes simplex virus causing:
        1. Mucocutaneous infection (for example, oral, genital, perianal) lasting for 1 month or longer; or
        2. Infection at a site other than the skin or mucous membranes (for example, bronchitis, pneumonitis, esophagitis, or encephalitis); or
        3. Disseminated infection; or
      3. Herpes zoster:
        1. Disseminated; or
        2. With multidermatomal eruptions that are resistant to treatment; or
      4. Progressive multifocal leukoencephalopathy.
    5. -- or --
    6. Malignant neoplasms:
      1. Carcinoma of the cervix, invasive, FIGO stage II and beyond; or
      2. Kaposi's sarcoma with:
        1. Extensive oral lesions; or
        2. Involvement of the gastrointestinal tract, lungs, or other visceral organs; or
      3. Lymphoma (for example, primary lymphoma of the brain, Burkitt's lymphoma, immunoblastic sarcoma, other non Hodgkin's lymphoma, Hodgkin's disease); or
      4. Squamous cell carcinoma of the anal canal or anal margin.
      -- or --
    7. Conditions of the skin or mucous membranes (other than described in B2, D2, or D3, above), with extensive fungating or ulcerating lesions not responding to treatment (for example, dermatological conditions such as eczema or psoriasis, vulvovaginal or other mucosal Candida, condyloma caused by human Papillomavirus, genital ulcerative disease).
      -- or --
    8. HIV encephalopathy, characterized by cognitive or motor dysfunction that limits function and progresses.
      -- or --
    9. HIV wasting syndrome, characterized by involuntary weight loss of 10% or more of baseline (computed based on pounds, kilograms, or body mass index (BMI)) or other significant involuntary weight loss as described in 14.00F5, and in the absence of a concurrent illness that could explain the findings. With either:
      1. Chronic diarrhea with two or more loose stools daily lasting for 1 month or longer; or
      2. Chronic weakness and documented fever greater than 38°C (100.4°F) for the majority of 1 month or longer.
      -- or --
    10. Diarrhea, lasting for 1 month or longer, resistant to treatment, and requiring intravenous hydration, intravenous alimentation, or tube feeding.
      -- or --
    11. One or more of the following infections (other than described in A-I above). The infection(s) must either be resistant to treatment or require hospitalization or intravenous treatment three of more times in a 12-month period.
      1. Sepsis; or
      2. Meningitis; or
      3. Pneumonia; or
      4. Septic arthritis; or
      5. Endocarditis; or
      6. Sinusitis documented by appropriate medically acceptable imaging.
      -- or --
    12. Repeated (as defined in 14.00I3) manifestations of HIV infection, including those listed in 14.08A-J, but without the requisite findings for those listings (for example, carcinoma of the cervix not meeting the criteria in 14.08E, diarrhea not meeting the criteria in 14.08I), or other manifestations (for example, oral hairy leukoplakia, myositis, pancreatitis, hepatitis, peripheral neuropathy, glucose intolerance, muscle weakness, cognitive or other mental limitation) resulting in significant, documented symptoms or signs (for example, severe fatigue, fever, malaise, involuntary weight loss, pain, night sweats, nausea, vomiting, headaches, or insomnia) and one of the following at the marked level:
      1. Limitation of activities of daily living.
      2. Limitation in maintaining social functioning.
      3. Limitation in completing tasks in a timely manner due to deficiencies in concentration, persistence, or pace.

    Jacques Chambers, CLU, is a Benefits Counselor in private practice with over 35 years experience in health, life and disability insurance and Social Security disability benefits. He can be reached by phone at 323.665.2595, by e-mail at jacques@helpwithbenefits.com, or through his Web site at www.helpwithbenefits.com.



      
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    This article was provided by Being Alive. It is a part of the publication Being Alive Newsletter. Visit Being Alive's website to find out more about their activities, publications and services.
     
    See Also
    More on Social Security for HIV-Positive Americans

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