Facts about Gastric Bypass 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. Gastric bypass is a surgical weight-loss technique to treat severe obesity, and it is the most common obesity surgery in the United States.
2. Gastric bypass is the chosen treatment technique when an individual cannot lose weight through diet and exercise and is experiencing life-threatening or life-impairing symptoms of obesity complications.
3. Gastric bypass alters the digestive system, limiting the amount of food an individual can intake. Gastric bypass is not a 'quick and easy' fix, it requires significant lifestyle changes too. Paired with exercise and diet gastric bypass can offer long-term and consistent weight loss, and limit obesity-related medical conditions.
4. Gastric bypass works by dividing the stomach into two parts. The main stomach is much smaller, leading to changes in the body and the mind's response to food intake. Both parts of the stomach are re-attached to the small intestine to allow for proper digestion.
5. The result of gastric bypass is typically dramatic and rapid weight loss, and can reduce the rate of obesity-related deaths by 40 percent.
6. Immediate complications of gastric bypass surgery are infection and bleeding, just like all with surgeries. However, additional complications after surgery may include vitamin deficiency, dehydration, hypoglycemia, hernia, food intolerance, and digestion problems such as gallstones, kidney stones, and stomach ulcers.
7. The decision for gastric bypass is made following a significant evaluation by a variety of medical specialists. A variety of health factors, as well as the individual's agreement to follow through with diet and exercise are important to the decision making process. If it is determined that the likely benefits of surgery outweigh the risks, then the individual is approved for surgery.
8. Before surgery, the patient must begin a regime of food restrictions, exercise and cessation of smoking. Following the surgery, the patient is not allowed to eat for one to two days, and then must follow a diet restricted first to liquids, then to ground-up and soft foods for about three months. Over time, the individual builds up to regular foods but the individual will not ever be able to return to previous eating habits.
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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