Facts about Osteomyelitis 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. Osteomyelitis means bone infection, which occurs through the blood stream, nearby tissue or direct trauma to the bone. Leg, arm, spine and pelvic bones are typically affected.
2. Osteomyelitis can be acute (no longer than several months) or chronic (long-term over months or years). When children have the condition it is mostly acute, and adults may have either acute or chronic osteomyelitis.
3. In general, osteomyelitis causes the infected area to become painful, swell up and turn red.
4. Other symptoms of osteomyelitis vary depending on whether it is an acute or a chronic condition. Acute osteomyelitis is more likely to cause fever as well as irritability and lethargy, particularly in young children. Chronic osteomyelitis is more likely to include drainage from an open wound.
5. Osteomyelitis occurs with trauma to the bone like a break, a deep puncture wound or surgery. Diseases and conditions that weaken the immune system make infection in the bone with these types of injuries more probable.
6. Men are more likely than women to develop bone infections. Age is less of a risk factor in developing osteomyelitis, although likelihood of developing specific types of osteomyelitis vary by age. Adults over 50 are most likely to develop infection in the spine.
7. Osteomyelitis used to be incurable but is now manageable, although it is still considered a serious medical condition and requires an aggressive treatment plan. The greatest risk is the spread of infection to other parts of the body.
8. Though the infection can typically be controlled, there are times when the infection may be uncontrollable and amputation may be necessary. Regardless of successful treatment, there is always the possibility that the infection will reoccur later.
9. Treatment always involves the use of antibiotics, and in chronic cases surgery is usually necessary. Surgery may involve increasing blood flow to the affected bone, draining the area or removing affected bone and tissue.
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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