Facts about Lyme disease 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.
Is Lyme Disease considered a disability by Social Security?
SSA does not have a listing in the Social Security Disability list of Impairments for Lyme disease. This condition, like most physical and mental impairments is not given a listing which sets forth specific disability approval criteria.
Despite this fact, a claimant who presents a case with lyme disease (and/or any number of other impairments) will have no difficulty being approved for disability as long as they can, through their medical records, demonstrate that they can satisfy the social security administration definition of disability.
Information on the disability definition and what it means for the processing of an SSD or SSI disability claim can be found here: Social Security Definition of Disability.
Facts about the condition
Lyme disease is the most common tick borne disease in North America. Deer ticks or western black-legged ticks are the most common carrier of Lyme disease, although there may be other ticks that carry the Lyme disease bacteria.
About eighty percent of the individuals in the early stage of Lyme disease experience the characteristic bulls eye rash (which may appear one day or even thirty days after exposure to Lyme disease bacteria), along with fever, sickness, and musculoskeletal pain.
Cardiac or neurological problems may occur in the acute state of Lyme disease, although it is rare. Late stage Lyme disease is considered to be a chronic condition that is very difficult to treat.
Untreated or persistent cases of Lyme disease may result in severe symptoms that may include a condition that is similar to meningitis and encephalitis, myocarditis, arthritis, psychiatric manifestations or neurocognitive problems. Chronic Lyme disease symptoms are so severe that they often lead to disability or even death for the infected person.
1) Lyme disease was named after the town it was first identified in 1975, Lyme, Connecticut, but no one realized it was a tick borne disease until 1978. Finally, in 1982 it was realized that Borrelia burgdoferi sensu stricto was the bacteria carried by ticks causing most cases in the United States.
2) Lyme disease is quite controversial. Some believe that the disease creates many symptoms that are ongoing, unexplained, and should be treated with long term antibiotics. Others believe there is not enough scientific evidence to connect these symptoms with the disease, or treat the disease for long-term.
3) If patients do not get treated by antibiotics, or treatment is administered too late or inadequately, the heart, central nervous system and joints can all be affected. Lyme disease is very serious and may lead to meningitis, Bell's palsy, memory loss, depression, fibromyalgia, and in extreme cases, paraplegia.
4) The first symptom of Lyme disease is a tick bite that turns into a circular, bulls-eye type pattern. This symptom usually shows up between 3 days and 30 days, and is thought to affect nearly 80 percent of those with the disease. Other early symptoms can include fever, muscle soreness, and headache.
5) Most cases of Lyme disease in the United States are caused by very tiny black-legged or deer ticks in the nymphal stage, and they must be attached for at least 24 hours for the transmission of Lyme disease to occur. Only 1 percent of tick bites are thought to result in the disease.
6) Diagnosis for Lyme disease is usually through symptoms, such as the bulls-eye rash, and exposure potential. If symptoms are present, laboratory tests to measure antibodies in the blood may be used.
7) To prevent Lyme disease protective, light colored clothing should be worn outdoors and ticks should be removed as quickly as possible. Guinea fowl eat ticks, and as a pet they can help reduce risk of ticks in one's home and Lyme disease.
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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