Facts about Polymyalgia Rheumatica 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. Polymyalgia rheumatica causes mild, arthritic inflammation in the shoulder and hip joints, leading to muscle aching, stiffness and pain. The most commonly affected muscles are the neck, shoulders, upper arms, thighs and hips.
2. Onset of polymyalgia rheumatica most often happens overnight, where the individual goes to bed feeling normal and wakes up with the condition. Polymyalgia rheumatica is not typically a chronic lifetime condition; rather, it heals itself after one to two years.
3. Aside from muscle symptoms, polymyalgia rheumatica also makes the affected individual feel fatigued, weak and generally unwell, and it causes the patient to lose weight and have anemia.
4. The pain from polymyalgia rheumatica can occur on one or both sides of the body, typically beginning on one side and progressing. Pain can be mild to severe and can cause trouble sleeping or staying asleep. It is typically worse after laying or sitting for an extended period of time.
5. Giant cell arteritis is associated with polymyalgia rheumatica, although not particularly common. Those with giant cell arteritis are much more likely to develop polymyalgia rheumatica, than are people with polymyalgia rheumatica to develop giant cell arteritis. Giant cell arteritis causes arteries to become inflamed. The temples are most often affected, but the neck and arms may be as well.
6. It is uncertain what causes polymyalgia rheumatica to develop, but it happens when the immune system starts attacking the lining of joints, such as in the hip and shoulder. White blood cells are normally responsible for fighting off foreign invaders that cause sickness, but in this case they also attack the joint tissues.
7. Although it may cause severe pain, polymyalgia rheumatica is considered to be a less severe condition overall than rheumatoid arthritis and other inflammatory conditions.
8. Women develop polymyalgia rheumatica twice as often as men do, and onset is almost always over the age of 60.
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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