Facts about Endocarditis 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. Endocarditis is a medical condition characterized by inflammation and/or infection in the endocardium, which is the inner lining of the heart. It is most commonly caused by a bacterial infection, that is caused by germs entering your bloodstream and attaching to already damaged or weakened heart tissue.
2. People with an artificial heart valve, congenital heart defects, damaged heart valve, or other heart defect are at the highest risk for endocarditis. It is not a common medical condition found in those with healthy hearts.
3. Although normal bacteria that live in your mouth or other parts of your body are the main culprit of endocarditis, it can also be caused by gum disease, a skin sore, an intestinal disorder, contaminated needles used during drug use, tattooing, or body piercing, certain dental procedures, a sexually transmitted disease, or anything that can cause bacteria to enter the bloodstream and make its way to the heart.
4. Symptoms can include fatigue, fever, chills, excessive sweating, joint pain, muscle pains, muscle aches, paleness, a heart murmur, night sweats, persistent cough and paleness. In some cases the abdomen, legs and feet may swell, there may be blood in the urine, and tenderness in the spleen.
5. The most common treatment for endocarditis is antibiotics, usually intravenously and in high doses. If more serious cases that include heart valve damage or persistent infection, surgery is needed.
6. Those with a high risk of endocarditis should take preventative antibiotics if they are having certain dental procedures or medical procedures that could allow harmful bacteria to enter the blood stream.
7. Diagnosing endocarditis may include blood tests, chest x-ray, a transesophageal echocardiogram (to see the heart at work and check the heart valves), an MRI (magnetic resonance imaging) scan or a CT (computerized tomography) scan, and an electrocardiogram (ECG).
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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