Facts about Polymyositis 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) Polymyositis is a disease affecting the connective tissues of the body, causing inflammation and weakness in many different muscles. The word polymyositis translates literally as many muscle inflammation.
2) Polymyositis affects: people between the ages of 30 and 60, women more than men, and African-Americans more than Caucasians.
3) Polymyositis usually starts gradually, in the muscles of the sides, hips, thighs, shoulders and upper arms. Weakness occurs in the same muscle group on both sides of the body simultaneously.
4) Polymyositis can affect the ability to speak, swallow and breathe normally. It can cause general fatigue, as well as well as tenderness in joints and muscles.
5) At the early stages of the condition, severity of symptoms can vary, being worse one week and better the next. Over time, however, the symptoms progress in severity and improvement is only seen with treatment. Polymyositis rarely has periods of remission or improvement of symptoms.
6) Progression can result in difficulty performing regular day-to-day actions such as rising from a chair, lifting up objects, or climbing stairs.
7) Polymyositis is part of a group of inflammatory myopathies, which are similar to autoimmune disorders. In these conditions, the body attacks normal tissue along with foreign invaders that cause sickness.
8) There is some indication that polymyositis may be triggered by infections, but typically the cause of the condition is unknown.
9) Treatment for polymyositis includes corticosteroids to increase strength and reduce inflammation and immunosuppressive drugs to help keep the immune system from attacking healthy tissue. Intravenous immunoglobulin consists of healthy antibodies from blood donations, and high doses can help block the antibodies that are attacking the muscles.
10) Physical therapy, dietary coaching, and speech therapy can all help manage the symptoms caused by polymyositis. Staying active and maintaining an exercise plan as recommended and approved by a doctor and physical therapist can help with muscle strength and fatigue.
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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