Facts about IC, Interstitial Cystitis 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. Interstitial cystitis is a long-term condition that is better described as painful bladder syndrome. This condition causes bladder pressure and pain, as well as pelvic pain, that can vary from mild to severe.
2. Women are most often affected by the condition.
3. Interstitial cystitis may come and go in flares, and may vary in severity at different times within the same individual. Flares may coincide with menstruation, allergies, stress and sexual activity.
4. Symptoms include frequent and urgent urination, localized pelvic pain, chronic pelvic pain and pain during sex. Affected individuals may experience different combinations of symptoms, or only one symptom, but most have both pain and urination problems.
5. These symptoms may seem like a urinary tract infection but, when cultured, urine shows up without any bacteria.
6. It is unknown exactly what causes interstitial cystitis, but it seems that the signals from the bladder get mixed up and cause more frequent urination than normal. In addition, there may be a defect in the lining of the bladder causing irritation of the wall and therefore causing the pain many feel with interstitial cystitis.
7. Women ages 30-50 are at the highest risk for developing painful bladder syndrome. Those who have chronic pain conditions such as fibromyalgia are also more at risk, although the reason why is unknown.
8. Complications of painful bladder syndrome include stiffening of the bladder wall and therefore reduced capacity to hold urine, a lower quality of life due to interference of frequent urination and pain on activities and work, relationship problems and strain on sexual intimacy, and emotional stress or depression.
9. There is a particular oral medication called pentosan that has been approved specifically for painful bladder syndrome. It is not understood how this medication works, but it is believed to help restore the bladder wall, increasing protection from irritating substances in urine. It typically takes up to six months to see a marked reduction in symptoms.
10. Non-steroidal anti-inflammatory drugs and antihistamines may also help reduce symptoms.
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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