Rotator Cuff Injury and Filing for Disability
While a rotator cuff tear is considered a severe medical condition by the Social Security Administration, it has no specific impairment listing in the SSA Blue Book. Rotator cuff tears fall under the classification of musculoskeletal impairments. If it were listed, it would be addressed in listing section 1.00, Musculoskeletal System- Adult.
Most shoulder conditions are evaluated under 1.02 Major Dysfunction of Joint. This listing requires that there be gross anatomical deformity (e.g., subluxation, contracture, bony or fibrous ankylosis, instability) and chronic joint pain and stiffness with signs of limitation of motion or other abnormal motion of the affected joint(s), along with appropriate medically acceptable imaging of joint space narrowing, bony destruction, or ankylosis of the affected joint(s). With: Involvement of one major peripheral weight-bearing joint (i.e., hip, knee, or ankle), resulting in inability to ambulate effectively. Or, the involvement of one major peripheral joint in each upper extremity (i.e., shoulder, elbow, or wrist-hand), resulting in the inability to perform fine and gross movements effectively.
Considering the requirements of listing 1.02, some will be able to meet or equal the listing. However, most people will have a hard time meeting or equaling the listing. It really comes down to the severity of the rotator cuff tear and the limitations caused by the tear along with the prognosis.
It is helpful if the claimant's medical records include a physical examination that shows limitations and pain levels. The findings of the examination should be supported by objective testing that includes: x-rays, ultrasound, cat scans, and MRI scans. Also, if possible they should have a statement from their treating physician that includes a description of the rotator cuff tear, pain levels, limitations to mobility, a prognosis, and their opinion as the their patient's ability to maintain employment.
Social Security disability determinations involve an evaluation of a person's past work and potential forother kinds of work if they are unable meet or equal an impairment listing.
Disability specialists use the information provided in the medical vocational work history to determine if claimants are able to perform their past work or other kinds of work. If they are found to be unable to do any of their past work or other work due to the limitations of their rotator cuff tear, they may be approved for disability benefits.
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 Rotator Cuff Injury
1. A rotator cuff injury involves damage to the muscles and tendons in the shoulder that connect the upper arm to the shoulder blade and help hold the ball of the upper arm into the socket of the shoulder.
2. Of all the joints in the body, the rotator cuff provides the greatest range of motion. Injuries usually occur from overhead repetitive motions (like throwing or lifting) but can also occur from impact, like a fall.
3. Symptoms of an injury to the rotator cuff include pain and tenderness in the shoulder. These sensations may be especially noticeable when reaching above and behind, lifting, pulling, and sleeping on the injured side. The shoulder may also be weaker than normal, have less range of motion, and the injured person may be less inclined to use the arm.
4. A severe injury may cause constant pain and weakness. Severe pain, pain that lasts longer than a week, and inability to use the affected arm are all signs that it is time to see a doctor.
5. There are certain factors that make some people more prone to rotator cuff injury. This includes a common factor, older age, but also includes lifestyle choices like being an athlete or working in construction and carpentry trades. Having poor posture and weak shoulder muscles are two other contributing factors that increase the risk of injury to the rotator cuff.
6. Most injuries are minor and will heal with home treatment, on their own. Appropriate care includes resting the affected shoulder, alternating application of ice and heat, taking over-the-counter pain medications like ibprofen or tylenol, and beginning gentle exercises after the first day or two.
7. More major injuries may require injection of steroid medication, surgery to repair tears, and even shoulder replacement surgery in the case of long-standing injury.
8. Staying active and limber is important to prevent injury. Daily exercises such as stretches and strengthening can help prevent future injuries.
Qualifying for disability benefits with Rotator cuff injury or any other 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 Social Security 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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