Month: January 2012

Normally when we talk about brain injury, we talk about it in the context of serious personal injury from, for example, drunk driving accidents, large truck accident, construction accident and highway accidents.  I want to talk today about brain injury in the context of the  Social Security Administration’s guidelines for disability.  You will remember from our previous discussions that there are two sets of rules used to determine whether a person is entitled to disability benefits; The Listings and The Medical Vocational Guidelines (The Grids). The listing specifically contains a listing for Brain Injury.  It is  in the Neurological section, Listing 11.18, Cerebral Trauma. As we also know medical documentation is crucial to establishing eligibility for disability. For brain injury, medical documentation of the acute phase (early on in the recovery) is usually easy to provide.  However, ongoing evidence of treatment in the post acute phase of recovery is also essential. 

This next part is for my readers who treat brain injury.  You can be of great assistance to your patient if, when you are asked to provide a report documenting your opinions about the patient’s ability to work, you write the report to include references to the medical record that support your opinions and conclusions.  Unsupported opinions carry little weight with the Social Security Administration.  Even if your opinions are dead on accurate,   if they are not supported by corresponding references to the record, you might as well have not taken the time to write the report. Please take your time when you write that report.  An accurate report to the SSA is very important to your patient’s well being.

Brain injury which causes severe neurological affect, i.e. paralysis, dysphasia, severe executive dysfunction, etc are fairly straight forward in terms of proof.  It is the brain injury which has responded well to treatment, but still leaves the survivor with subtle issues such as fatigue, short term memory loss and the need for increased completions times.  These survivors also face the well known prejudice, “They look okay, they must be okay”.  For these survivors, the report may well be the most important piece of evidence.  I also suggest letters from failed work attempt employers and or failed class teachers. Many times survivor’s recoveries are significant,  and relative to their immediate post injury condition, the patient is doing very well.  This, however, does not always mean the patient is back to their pre injury function or that they can return to employment. So, doctors, you must explain in your reports that although the patient has improved significantly, that does not mean they are employable in a competitive job.  You must point out why this is using references to your medical records.  Otherwise it is too easy for the SSA to say, well they look good and the doc says they are much improved, they must be able to work.

The Social Security Administration requires that a claimant supply medical information to support the claim for Social Security Disability Payments and Supplemental Security Payments.  This means that if you have a disabling condition, but you have not sought medical treatment, or the medical testing does not demonstrate a medical condition which would likely be causing the disabling condition, your chances of obtaining Disability benefits are markedly reduced.  This poses a very difficult problem for those who are uninsured and have little or no funds to pay for medical treatment. Fortunately Medicaid is available to help obtain medical care.  In Marion County Wishard Hospital offers care for the poor.  Unfortunately the Medicaid program is overburdened as is the Wishard facility.  This causes delay in obtaining medical care, and thus cause delay in obtaining medical evidence which will support a disability claim.

If you are fortunate enough to have insurance and have medical documentation of a disabling condition, the medical records alone may not be enough to prove your claim.  In the case of chronic pain, or a brain injury, or chronic fatigue, often times the effect of the condition on the body is more severe than conventional testing can detect.  In the case of pain, there is generally no objective test to support the claim.  Thus the Administrative Law Judge will be forced to make a decision about whether he/she finds the claimant’s complaints “Credible”.  The first step in this process is to determine whether the claimant has proof of a medically determinable impairment.  The next step is to determine what symptoms, including pain, the impairment(s) is likely to produce.  The third step is to determine what limitations the impairment(s) is likely to produce in terms of ability to lift, walk, sit, and stand.   The next step is to obtain information from the claimant, in the form of testimony y, doctors records and test results.  The ALJ compares the medical report information with the claimant’s testimony to see if they are consistent.  If they are consistent, your credibility goes up.  If they are inconsistent your credibility goes down.  Being given less than full credibility can result in you being denied your benefits. The lesson here is to be fully honest with your doctors and the Administration.  In that case, your credibility will  likely go up and improve your chances of obtaining your disability benefits.

As your Indianapolis Social Security Lawyer, with more than 23 years of experience representing claimants before the Social Security Administration, I am always asked, “Do I need a lawyer to file my initial claim?”  My answer is probably considered a typical lawyer answer, and that is it depends.  If you are confident in dealing with bureaucrats, or are handy on the computer, and have reasonably good organizational skills then I would say you probably do  need a lawyer for the initial application.  If you are a little skittish, have memory problems or organizational issues, then it may be a good idea to have help at this phase.

                There are a few ways to apply.  In no particular order, you can apply online, over the phone or through an in person interview.  If you require the assistance of a lawyer in applying   I would assist you in applying on line.  The Social Security Administration website is easy to use and helpful.  You can access the site at www.ssa.gov. On the first screen there is a pull down tab for your application.  Click on this tab and away you go.  If you go to your local SSA office, you will apply in person.  These folks are generally helpful and take some of the worry out of the application process.  The down side is that you have to leave your home and the lines at these locations can be problematic. 

                No matter what method you choose to use, a few preparations will make the process less stressful.  Make four lists. 1. List of medical care providers with addresses. 2. List of Medications with side effects. 3. List of all illnesses, injuries or diseases which cause you to be disabled, and finally, a list of your employers for the last 15 years.  This is essential information that might escape you at the time of application. 

                If you have any questions, or help call John P. Young at 888-639-5161 or email Mr. Young at john@youngandyoungin.com.