Facts about Encephalopathy and Filing for Disability
These selected pages answer some of the most basic, but also some of the most important, questions for individuals who are considering filing a claim for disability benefits.
Facts about the condition
1. Encephalopathy effects various areas of the brain, and is a symptom of other conditions. It occurs in many different forms, and is a broad term encompassing many brain dysfunctions.
2. In some instances encephalopathy causes permanent changes in the brain and its functioning, and it can continue to worsen. In other cases, it may be reversible. This all depends on the type of encephalopathy and the cause of the dysfunction.
3. Different types of encephalopathy have different prognoses. Some types of encephalopathy are most definitely fatal, while others can be treated and at least managed, if not reversed entirely.
4. There are many different causes of encephalopathy, but all encephalopathy is characterized by alteration and dysfunction in the brain. Infection from bacteria or a virus can cause encephalopathy, as can improper metabolic or mitochondrial functioning, chemical and toxin exposure, radiation and poor nutrition. Abnormalities in the brain such as a tumor, pressure, lack of oxygen or blood flow also all lead to encephalopathy.
5. Symptoms of encephalopathy include cognitive problems, personality changes, difficulty concentrating and lethargy. There may also be involuntary muscle movement, rapid loss of muscle tone, seizures and respiratory problems.
6. Mad cow disease (bovine spongiform encephalopathy) is one of a group of conditions categorized as transmissible spongiform encephalopathy, which make holes in brain tissue (causing a spongy look), impair movement and coordination, and cause death.
7. Permanent brain damage is characteristic of toxic (from chemical exposure) encephalopathy, hypoxia (very limited oxygen to the brain), and static (unchanging) encephalopathy.
8. Diagnosis of encephalopathy typically comes from assessing all symptoms along with a lack of specific test results. The cause may be determined through blood tests, spinal fluid analysis, imaging tests and electroencephalograms.
9. Treatment varies but includes medications for seizures, changes to diet and nutrition, and even organ replacement in the most severe cases. Treating the underlying condition is often the most effective at stopping or reversing brain damage.
Qualifying for disability benefits with this condition
Whether or not you qualify for disability and, as a result, are approved for disability benefits will depend entirely on the information obtained from your medical records.
This includes whatever statements and treatment notes that may have been obtained from your treating physician (a doctor who has a history of treating your condition and is, therefore, qualified to comment as to your condition and prognosis). It also includes discharge summaries from hospital stays, reports of imaging studies (such as xrays, MRIs, and CT scans) and lab panels (i.e. bloodwork) as well as reports from physical therapy.
In many disability claims, it may also include the results of a report issued by an independent physician who examines you at the request of the Social Security Administration.
Qualifying for SSD or SSI benefits will also depend on the information obtained from your vocational, or work, history if you are an adult, or academic records if you are a minor-age child. In the case of adults, your work history information will allow a disability examiner (examiners make decisions at the initial claim and reconsideration appeal levels, but not at the hearing level where a judges decides the outcome of the case) to A) classify your past work, B) determine the physical and mental demands of your past work, C) decide if you can go back to a past job, and D) whether or not you have the ability to switch to some type of other work.
The important thing to keep in mind is that the social security administration does not award benefits based on simply having a condition, but, instead, will base an approval or denial on the extent to which a condition causes functional limitations. Functional limitations can be great enough to make work activity not possible (or, for a child, make it impossible to engage in age-appropriate activities).
Why are so many disability cases lost at the disability application and reconsideration appeal levels?
There are several reasons but here are just two:
1) Social Security makes no attempt to obtain a statement from a claimant's treating physician. By contrast, at the hearing level, a claimant's disability attorney or disability representative will generally obtain and present this type of statement to a judge.
Note: it is not enough for a doctor to simply state that their patient is disabled. To satisy Social Security's requirements, the physician must list in what ways and to what extent the individual is functionally limited. For this reason, many representatives and attorneys request that the physician fill out and sign a specialized medical source statement that captures the correct information. Solid Supporting statements from physicians easily make the difference between winning or losing a disability case at the hearing level.
2) Prior to the hearing level, a claimant will not have the opportunity to explain how their condition limits them, nor will their attorney or representative have the opportunity to make a presentation based on the evidence of the case. This is because at the initial levels of the disability system, a disability examiner decides the case without meeting the claimant. The examiner may contact the claimant to gather information on activities of daily living and with regard to medical treatment or past jobs, but usually nothing more. At the hearing level, however, presenting an argument for approval based on medical evidence that has been obtained and submitted is exactly what happens.
About the Author: Tim Moore is a former Social Security Disability Examiner in North Carolina, has been interviewed by the NY Times and the LA Times on the disability system, and is an Accredited Disability Representative (ADR) in North Carolina. For assistance on a disability application or Appeal in NC, click here.
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