Facts about Hernia 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) A hernia happens when an organ extends beyond its normal placement where it is contained by the muscular wall. This is usually due to a thin muscular wall or a small tear or weak spot in the muscular wall that allows the organ to push through.
2) There are different types of hernias, depending on the area they occur in the body. An umbilical hernia is a hernia that occurs around the navel, an incisional hernia happens due to scarring during abdominal surgery, a hiatal hernia occurs when the stomach pushes up through the esophagus, a femoral hernia occurs in the upper thigh, and an inguinal hernia occurs in the scrotum or groin. The most common type of hernia is located in the abdomen.
3) Symptoms of a hernia can include tenderness, unusual lumps, pain and discomfort in the area the hernia is present. These symptoms can increase when lifting something heavy or bending in certain ways.
4) Hernias may be due to lifting heavy objects, but they are also more likely to occur if you have extra weight, a family history of hernias, an enlarged prostate, cystic fibrosis, chronic constipation or cough, or undescended testicles.
5) Children and even infants may also develop abdominal hernias due to an underdeveloped lining around their organs. Boys are more likely to develop a hernia than girls.
6) Getting treatment for a hernia as soon as possible is vital. Left untreated hernias can lead to serious complications, from multiple organ dysfunction syndrome, necrosis, ischemia, gangrene, and even death.
7) Hernias are generally treated by an surgical procedure called herniorrhaphy. This requires the surgeon to push back the organ into its natural placement and strengthening the muscular wall to keep it in place.
8) To reduce your chances of developing a hernia keep your weight at a healthy level, exercise regularly, drink plenty of water, and make sure to get enough fiber in your diet. It is also important to be careful when lifting heavy objects, using correct lifting methods that lessen strain.
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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