Autonomic Dysfunction, POTS, ME/CFS, MCAS, and EDS - Your Eligibility for Social Security Disability Benefits

Welcome to Season 3, Episode 22 of Winning Isn't Easy, the podcast dedicated to navigating the complexities of disability insurance claims. In this enlightening episode, we delve into the intricate world of Autonomic Dysfunction, POTS, ME/CFS, MCAS, EDS, and their impact on your eligibility for Social Security Disability Benefits. In this episode of Winning Isn't Easy, Nancy speaks from a presentation given for a Facebook group that supports said communities.

Join us as we explore the unique challenges individuals with Autonomic Dysfunction, POTS, ME/CFS, MCAS, and EDS face in securing Social Security Disability Benefits. Our expert host, Nancy L. Cavey, a seasoned disability attorney, unravels the complexities of these conditions and provides invaluable insights into the claims process.

Through compelling discussions, we'll dissect the medical evidence required to support your claim, discuss common obstacles faced during the application process, and offer strategies to effectively advocate for your rights. Whether you're personally dealing with these conditions, or seeking a deeper understanding, this episode equips you with the knowledge to navigate the intricacies of Social Security Disability Benefits.

Tune in to empower yourself with information that can make a difference in your journey to secure the benefits you deserve.


Resources Mentioned In This Episode:

LINK TO ROBBED OF YOUR PEACE OF MIND: https://caveylaw.com/get-free-reports/get-disability-book/

LINK TO THE DISABILITY INSURANCE CLAIM SURVIVAL GUIDE FOR PROFESSIONALS: https://caveylaw.com/get-free-reports/disability-insurance-claim-survival-guide-professionals/

FREE CONSULT LINK: https://caveylaw.com/contact-us/


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Transcript

Disability Attorney Nancy L. Cavey: 0:11

To this episode of Winning Isn't Easy. I was recently asked to speak at the Autonomic Dysfunction Support Group, and what I spoke to them about is highly relevant to your ERISA disability claim. Now, if you take a look at your policy or your plan, you'll see that you're probably required to apply for Social Security Disability benefits. The reason is that the disability carrier plan has the right to reduce your benefits by the receipt of your Social Security benefits and potentially the benefits of your children. If you don't apply, the disability carrier plan is gonna act as if you are getting those benefits. So in this , uh, episode , uh, I'm going to show you , uh, my presentation from the Autonomic Dysfunction Support Group presentation that I did, and I'm gonna talk about the five step sequential evaluations, the claims process, how lawyers get paid, why you should have a Social Security Disability lawyer, and other relevant and important information. I hope you enjoy this because it does impact your ERISA disability claim .

Cindy Brown: 1:16

Okay. Welcome everyone. We're so happy that you're here to join us today. Um , we're excited to have this presentation and look forward to the questions and answers that you'll all receive. I'm gonna turn it over to Morgan, my COAD administrator, who will read the disclaimer.

Morgan - Group Representative : 1:38

Okay. So by participating or listening to this content, you agree not to use the information presented here as medical or legal advice in treating any medical condition. This form does not constitute a physician, patient or attorney-client relationship. The content here is for informational and educational purposes only. And because each person is so unique, please consult your healthcare professional or attorney for any medical or legal questions.

Cindy Brown: 2:02

Thank you, Morgan. I'd like to , um, take the opportunity to welcome Nancy L with , uh, Cavey Law. She's , uh, the afternoon speak with us , and I thanked her . I , she's in the chat . Please help me in welcoming Nancy .

Disability Attorney Nancy L. Cavey: 2:28

Well , thank you for us . Um, I'm gonna be speaking today on autonomic dysfunction pots , M E C F Ss, M C A S E D S, and your eligibility for Social Security disability benefits. Um , so I've got a lot of slides to go over and we're gonna take a break. Um, after I go through the social security portion of the presentation, I'm gonna talk about each of these medical condi medical conditions specifically , uh, and individually and collectively so that you understand how what I've taught you about social security applies to each of these medical conditions. And we're gonna be taking questions , um, at the end. I too have to give a legal disclaimer. Uh, this presentation does not create an attorney-client relationship with myself or my firm, and it doesn't constitute legal advice. But with that, let's get started. The topics I'm gonna talk about are Social Security Disability and ss, ss i , the five subsequential evaluation, the claims process, winning a claim, and proof problems, how attorneys get paid, why you need an attorney. And then I'm gonna go through all of these medical conditions , uh, individually, and then we'll talk about the interaction of them. And as I said, I'll take questions at the end. So let's get started with the wonderful world of Social Security. There are two types of Social Security , uh, benefits. The first is , uh, social Security Disability, and the second is the supplemental benefits. S s I . Social Security Disability is an insurance program. It's a disability program that's based on the payment of your FICA taxes of 20 out of the last 40 quarters prior to filing an application. Now that the , uh, number of quarters vary , uh, based on your age, but for the most part it's 20 out of 40 quarters. That means that you're insured, but you need to understand that the insured status will end and it will generally end about five years after you last work and your contributions , uh, cease. So it's really important that we are timely filing for Social Security Disability, as you'll hear , um, as I explained later, it's gonna take a year and a half to two years to get through the claims process. And if for some reason, you know, you're able to get back to work, that's great. But if you lose your insured status , uh, in this standpoint, you'll have to prove that you're disabled from a , the day you claimed your disability benefits, and then the day you lose your insured status. So we'll talk about that more if anybody has any questions. That's why it's important that you timely file a Social Security disability application. Now, s ss d I will pay benefits from the sixth month of disability or 12 months before the application , um, whichever is later in time. Um, S S D I , uh, is going to , um, be paid based on your earnings history, and it'll pay a maximum of $3,627 per month . Social Security uses what's called a c e average current earnings, and we'll look at your five highest year's earnings to determine the amount of your benefits. Uh, there are no increases, if you will, except for COLA increases. So whatever your S S D I benefits are based on your earnings record is basically what it's going to be. Now, you also become eligible for Medicare after 29 months of disability. So the first five months, you don't get any benefits, even though you may be found to be disabled, that's true for everybody. And then you have to be on Social Security Disability for 24 months before you became eligible for Medicare. So that's where we get the 29 months. Now, SS s i is available to anybody who's legally in the United States, but it's an asset based test . So you can only have $2,000 , uh, if you're single or $3,000 if you're married in , in assets , um, cars in house are not included. You get instant Medicaid and the monthly payment is capped at $914 per month. And you can , uh, have to maintain your , uh, assets within these asset levels, or you can lose your eligibility for SS s I . So now we've set the parameter for ss, S D I ss, SS I, and before I move on, most doctors understand that SS S D I I is something that you've worked for, you've contributed to. There are some doctors who think that ss, SS d i is welfare and they don't want to support welfare queens or kings. Uh, I try to educate physicians about their misconception about that and, and say, Hmm , look at your own pay stub. You'll see where you have these FICA withholdings, and doctor, I'm sure you don't think that you're a welfare king or clean queen if you were to apply for benefits because you've been contributing to this system. So what's the five step sequential evaluation? Uh, we have to start out with a definition of disability. And just because your doctor says you're disabled or you think you're disabled, doesn't mean that you meet the Social Security standard for disability. It's a term of art. It's defined as the inability to engage in any substantial gainful activity by reason of any medically determinable , physical or mental impairment, which can be expected to result in death or which can last or can be expected to last for at least a continuous period of not less than 12 months. So there's a lot of words in this definition. Um , and we're gonna break some of these down so that you understand how this , uh, definition is actually applied in practice. Now , uh, on this , uh, screen, you can see the five steps sequential evaluation, and it is just that sequential. If you don't meet step one, you're denied. If you don't meet step two, you're denied. If you don't meet step three, you're not denied, but we go on to steps four and five. If you don't meet step four, you're denied depending on your age. And if step five, if you don't meet that test, you're denied. So we have to go through every one of these steps, but at any one of these steps, with the exception of three, you can be kicked out. So I'm gonna break this down in , in layman's terms, the five steps . Sequential evaluation basically says, are you working? Two, is your medical condition severe? Three, does your medical condition meet what's called a listing? Number four, can you do the lightest and simplest job you held in the last 15 years? And five, can you do any other type of work in the mythical hypothetical, not real world , world of work that you wouldn't want to do and doesn't pay a living wage in view of your age, your education, the skills that you have learned in your past work and your functional abilities, your restrictions and limitations. Now, let's talk about step one. Are you working? So the question becomes, does your medical condition prevent you from performing substantial gainful work on a full-time basis, earning less than 1470 per month? So you can work, but if you earn 1471, you're not eligible for benefits because you have exceeded the , uh, what's called the S G A . Now, I have clients that bouncing back and forth above that level. I don't like that. I think it makes it more difficult to win a case. Um, I prefer that my clients really keep it well below the 1470, because the judge will say, well, you know, you're a hundred dollars close, you're 1370. Why can't you work a couple more hours or a couple more shifts to get over 1470? And if you bite on that and say, well, you know, I could do that, the judge is gonna rule against you. So if you're gonna work, please keep it under 1470. Number two, is your medical condition severe? Now, this is designed to weeded out cases where there's only minor limitations on your ability to work, or where your medical condition won't significantly limit the ability to perform basic work activity for at least 12 months. So that 12 month period is an important , um, consideration. Sometimes social security will say, well, we think you're gonna get better in 12 months, so we're not going to deny your claim. And that can be a hurdle for people who have slow progressing medical conditions or which vary in intensity and frequency. Number three, I'm gonna take us back to biology. When we studied biology, we learned biology in terms of body systems. And the Social Security Administration takes a systems-based approach to the analysis of a claim. There are, there's a book called the Blue Book or the Listing of Impairments, and we can open up various sections to see whether or not potentially the medical condition qualifies , uh, as a listed condition, and if so, whether or not people meet the listing. Now, medical records have to document the elements of a listing or the medical equivalent of a listing. But as I tell my clients , um, doctors didn't go to medical school to write a report that meets every element of a listing if your medical condition has a listing. So the majority of the time, while I try to develop an impairment at the listing level, the reality is these step cases are decided at steps four and five of the five steps sequential evaluation. Now, as I said, you have to meet every element. And if you meet every element at step three, your benefits are automatically awarded. And if you don't, then we go on to address how your symptoms impact your ability to function. My clients love two words that have them drilled in their heads, systems and symptoms and functionality. Now, I think that is it really crucial that you ultimately get a form filled out by your physicians called residual functional capacity forms. If your medical records don't address and most don't, your level of functioning social security will do one of two things. They will have a consulting physician review your medical records, and you can imagine that they're being paid by Social Security. They're not necessarily inclined to say that you are , uh, unable to do sedentary work or, and generally say that you're able to do light work . Most of these doctors haven't been practicing in a million years, but that doesn't mean that social security won't recognize their opinion. So I always want my client's physician to complete a residual functional capacity form. Now, these forms were developed by lawyers generally , uh, but Dr. Trevino's , uh, great , uh, uh, PA has developed a POTS residual functional capacity form. Uh, and I think it's fantastic and we have adapted it and we use it in our practice. By the way, I have a nationwide practice , uh, for both social security and ERISA disability benefits. And we use that POTS form regardless of where our clients live and regardless of whether or not it's a social security case or an ERISA disability case. Now, what's important about this form is that social security is gonna compare your restrictions and limitations to the functional requirements of the lightest job job you did in the, the 15 years before you became disabled, both physically, cognitively, and emotionally. Um, and so at step four, and I think at step five, the key is to have this residual functional capacity form. There are many times I use more than one. It's not unusual for my clients to be depressed, have panic attacks. So , uh, I am going to ask them if they're seeing a psychologist, psychiatrist, or mental health person to get a psychiatric residual functional capacity form completed in addition to a pot swarm or whatever applicable form , uh, that we can use. And as I said, many times, we'll use more than one because I never argue that there's just one disabling condition. I argue each condition individually and then collectively, because after all, you're a whole person. And I want the security administration not to parse your claim in terms of specific disabilities, but to , um, see you as a total individual and consider the whole spectrum of disabling conditions. So, as I said, the key really is step five. Can you do other work in the national economy? Mythical, not real world hypothetical in view of your age, education, work experience, and your capabilities? I'm gonna give you a little shorthand key to winning , um, so that you understand what it is you need to prove. Now, generally, if you're under age 50, you have to be unable to perform sedentary work. And as I explained to my clients, it's the ability to lift maximum of 10 pounds, sit six, occasionally, walk and stand two hours out of an eight hour day. Now, I'm sure you all say, well, I can't even do sedentary work. It's very hard to get the Social Security Administration to, to buy that, particularly if, if we have a younger individual. But there are ways that we can get around this particular bias in , uh, in sedentary work, many times social security of the judges will say that you can do light work , and I'm gonna use a technical term. We have to erode that ability to do light work so that basically we destroy the ability to do it on a full-time sustained basis. Now, if you're underage 50, I have to tell you, and particularly if you're in your twenties or thirties, there is a significant bias that Social Security has against younger individuals. They think that because a person is young, they can be retrained, they can go to school, they can learn simple routine tasks and work at a job like McDonald's. These cases are winnable. I just want a case two weeks ago involving a 23 year old woman who had pots. So , um, it, each case obviously is unique. And when I get a case where I have someone under 50, I'm very well aware of that bias, and I'm working hard to help overcome that bias. In our R F C forms, in our medical records, the forms that you fill out and your preparation at trial. Now, if we go to a hearing, you need to understand that first, the judge is not bound by the any earlier denial. So the judge gets to exercise their own independent judgment. Most of the time there are just two witnesses, you and , uh, the vocational evaluator. And with all due respect, they don't wanna hear from your mother, father, brother, sister, best friend. They're not interested in any of that because they think those people are biased. Now, that isn't to say in the right case, I don't use them, but it's going to be you and the vocational evaluator. There might be a medical , uh, claims examiner , um, who , or a medical examiner who will be asked to testify Now at the hearing stage, which is about 45 minutes, the hearing is about 45 minutes. And we do these , uh, these days by phone or by zoom. Very rarely are we having in-person hearings. The judge is going to give that vocational evaluator that other person a hypothetical. After you testify first 30 minutes, you last 15 minutes, the vocational evaluator, and you're not gonna understand the language and it's gonna go really, really quickly. But they're gonna give a hypothetical about your age education skills, and the answers , well, the , the hypothetical and the answers to that hypothetical will make or break your case. And I'm gonna talk about that later. And I'm gonna actually give you an example of how this hypothetical works. But that is an overview of the five step sequential evaluation. So now we've sort of got the overview. Let's talk about the claims process. And that's confusion, delay in denial. Um, I have some other words that I use for it, but , um, there's a three step administrative process. There is the initial application, the request for reconsideration in the hearing, the IA is sent to a state agency called the Office of , uh, disability Determination Services. Uh, uh, d d s , um, and I have a nickname for them. Um, it's Dumb Dumber and Stupid. Um, that's a joke, but it's not a joke in that , um, because of staffing issues, because of the lack of training, there's about a 90% denial rate. Now, that denial is also something that you contribute to, and that is no doctor records, no doctor support. A failure to accurately describe your symptoms and functionality. A failure to accurately describe your work duties. And I promise you, if you don't have doctor records or doctor support, there's a good chance that social Security in the initial stage is gonna send you out for a consultive medical exam , A C M E , you gotta go. Um, but it's not unusual for an unqualified doctor to perform that. I recently had a pediatrician perform an a , uh, a , uh, ce , uh, in a case. Um, and obviously I'm objecting to the , the weight of that opinion because a pediatrician doesn't know a whole lot in this particular case about a back condition. So you gotta go. Social Security does look at it. And if, if the judge is looking for a reason to deny the claim, they will give significant weight to that consultive exam and ignore what your doctor has to say. 'cause there's no treating physician role in Social Security. They're not bound by what your doctor has to say. The initial application is confusing. It's time consuming. It's easy to make errors in my office. We actually help the clients complete the application. And it's a , a , a pain, but it's a process that needs to be done. Uh , particularly making sure that you have all your doctors listed. More importantly, you're given a good , uh, work history. When you look at the work history form, by the way, you'll see that it only asks questions about the physicality of your occupation, and no questions about the cognitive aspect of your work, and no questions about your interaction with others. I call it the psychosocial aspect of your work. So on the back page, the blank page of the work history form, I'm making sure that my clients are describing those types of duties. Now, right now it's taking about 250 days , uh, in some parts of the United States, it's longer, and it's taking that long just for them to assign, assign a claims examiner. So in that process, you need to continue to get medical care. We still wanna be submitting those medical records and , um, and forms. Now, if your claim gets denied, as 90% of them do, you have to file what's called a request for reconsideration. And you have to do that within 60 days of the day of the decision, or you get to start all over again. Uh, it's reviewed by d d s and they didn't get any smarter, and we still have that 90% denial rate. It's about 150 to 250 days to get a decision. And again, you can make mistakes. If you're getting new diagnostic studies, you're changing doctors, you're getting new kind of treatment, there's been a change in your functionality, all that information should be submitted to Social Security. So once they finally open up the file, hopefully they'll look at the records and there's this additional information that should make a difference if the claim gets denied a second time. The third appeal is called a request for a hearing. And you gotta file it within 60 days of the day . The denial order , you get to start all over again. Again, it can take 16 to 24 months or longer to get a hearing from the time of the initial application or longer, depending on where you live. In the United States, the judge is going to be using the five step sequential evaluation, and they're not bound by that earlier, earlier denials. And the approval rates will vary by judge, unfortunately. Um, 45 minute hearing. And in 45 minutes, you've got the first 30 minutes to put on your case. Um, in my particular situation , um, what I think is key is the lack of claim development and the lack , uh, and , and preparation. And so I'm gonna talk about this in our next , uh, slide. Um, there are, there are common proof problems that are gonna sink a claim. One is generally not having a residual functional capacity form and an unfavorable C M e uh, exam. Uh, incomplete forms failure to cooperate with the Social Security Administration. So they say, we're gonna send you to A C M E , and you say no, or they send you forms and you don't fill them out. Um, you don't return their phone calls. Um, your medical records don't tell the story of your symptoms and functionality. Um, you don't have residual functional capacity forms. The right ones were them not completed properly. And then there's a lack of proper claim development and a lack of , uh, preparation I to my clients that claim development starts with you. I like my clients to do what I call a symptom and functionality worksheet that we like to look at before each doctor visit. We want to give the doctor a really good interval history of what are your symptoms and how those symptoms impact your ability to function with some examples. So , um, you know, I have difficulties , uh, rising from a , a , a chair and, you know, five times at a six, you know, I'm gonna fall down. Um , and if I fall down, you know , I've, I've, you know, broken my wrist, I've broken my elbow, blah, blah, blah type thing. So what is the symptom and how does that symptom impact your ability to function? I can't stand up at the sink to even wash , um, a off a coffee cup because I get faint. My heart rate drops, my blood pressure, you know, changes, and down I go. Um, so think about your symptoms and think about how your symptoms impact your ability to function and make sure that story's being told in your medical records. Now, the other part of the claim development, again, is that R F R F C form. If you're at the hearing stage, lack of preparation can be fatal. Um, you can't go in and watch a social security hearing. So I've shot a mock social security hearing video, so you can, my clients get to see it. Um, but unfortunately, some people won't meet their Social Security lawyer until the hour before the hearing, and that's not how it should go. You should be working closely with your Social security attorney's office and the attorney. Um, six weeks before a hearing. In my cases, I send out something called the direct examination video. It's an hour long video that goes through every question. One potentially could be asked, and I'm teaching people how to truthfully and accurately tell their story. But we also have a direct exam worksheet where my clients will write out all the answers to those questions and an updated symptoms and functionality worksheet. Then as part of this preparation, I have a practice session with them. I go over the logistics of the hearing, but I play the judge. They play them, and we practice those answers so that they learn how to testify and explain all of the things that need to be explained in 30 minutes in a way that the judge understands. So, lack of preparation, lack of claim development can be , uh, fatal. As part of that preparation, I do a memorandum of law, five pages long, and that's all we can do. Uh, and obviously I'm there making sure that my client's testimony is accurate and complete, and I'm there to cross examine the vocational evaluator and explain what it is. Uh, uh, the theory of the case is . Now, let's talk about these in greater detail. Inaccurate forms or , uh, incomplete forms. Not completing them, not considering all of the disabling medical conditions, not providing complete medical information about the providers, the kind of diagnostic studies you've had, not providing medication information. Uh, and on the other side, we've got , um, inaccurate work history. We have inaccurate information about the date of the disability, and we have inaccurate information from third party sources. You're gonna be asked to name some people who will be asked to fill out some forms. And I've seen what the, what these people's forms have done to claims they can destroy them. Because ultimately, a judge has to determine your credibility. And if the judge thinks that you and your third party source statement are exaggerating, then the judge isn't gonna believe you. And the judge has the ability to determine your credibility, which can sink your case, failure to cooperate, failing to call them back, failing to attend consult exams, failing to attend a hearing. Um, medical records. I have a new medical term for you. It's d d d document deficiency disease. And if you've ever read your medical records , uh, and I read a lot of them, sometimes you have to translate whether medical records into English , uh, because they're very vague or incomplete. I try to make sure that, that the records are telling a story. And that might mean that we are supplementing the chart with that symptoms and functionality worksheet that I want my clients to fill out and be made part of the client's chart. Of course, the a residual functional capacity form is crucial, particularly if the chart notes are deficient. But I will tell you that judges will say, well, how did we get from that chart note to this R F C form? 'cause I don't see this in the records. So the question is, is the chart clear? Is it generated by CCPT codes, ICD nine codes? Is it menu generated ? Can you read the handwriting? Now this all assumes, of course, that your doctor supports your claim. And if the doctor does not support the claim , um, it is my legal advice that you find another doctor, because you cannot win a claim generally, particularly these kinds of claims, without the support of a physician. Now, this is something that you need to be very careful about. You may be asked, well, how are you doing? And you might say, oh, I'm feeling better. Any new complaints? No, I don't have any new complaints, any changes. No, my condition's the same. Well, that's vague. And that kind of language can be seized on by a judge as an indication that you've recovered and you're able to work. So, I don't ever say feeling better. I feel fine. There are no new complaints. Make sure you're telling the doctor what your symptoms are and the functionality, and if possible, have that , um, supplemental , uh, uh, form as part of your medical record. Now, I think a good chart requires teamwork with a patient and the doctor, and it requires comments on functionality in terms of exertion and non exertion. What do we mean by exertion? That's pretty clear. Sit, stand , walk , stoop bend , um, lift non exertional is the need to alternate sitting and standing problems with bilateral manual dexterity, problems with pace, problems with concentration, problems with attendance , um, those kinds of things. And so if you're having trouble with sustained activity, you might wanna say, you know, I can only get outta bed for 30 minutes and I'm fatigued , uh, and I have to take a DAP for 15 minutes and I have to take , uh, um, uh, and that happens, you know, five times a day. So you're telling the doctor what the symptom is, the fatigue, how it impacts the ability to function. So a good chart should comment on your functionality and tell us true story without the need for a translator, the R F C form, you have to have the diagnosis as basis of the diagnosis. We have to have a report of the symptoms, we have to have a report of the physical functional limitations, the cognitive functional limitations. And if it's a , a psych R s C form, it'll be much the same except for it'll be the psychiatric functional limitations. So non exertional impairments are really important to be developed in these cases. So postural limitations, manipulative limitations, environmental limitations, smoke, for example, mental and sensory impairments. You might have to alternate sitting, standing, elevate your legs. You may have difficulty bending, stooping, squatting, all of that should be in your medical records, but should be addressed , uh, in that R F C form because ultimately we have to prove for the most part that you can't even do a sedentary job doing bilateral manual dexterity, maintaining the pace production and attendance requirements. So I'm always cognizant of when I'm listening to my client, what are the complaints that they have , uh, that we can use to establish that they can't even do sedentary work. So if you've got difficulty with reaching, grasping, handling fingering, relating to others, understanding or carrying out simple instructions, if you have problems with concentration or poor stress tolerance, those are the kinds of things that we wanna be developing in your medical records. And as an aside, I wanna tell you that many of my clients, as I said, are depressed and have problems with anxiety and panic attacks. Unfortunately, the security administration thinks that everybody's depressed and that notwithstanding that, that everybody can work. So you're not, it is very difficult to win a pure psychiatric claim. Uh, and so I'm always wanting to develop both the physical problems my client has and the psychiatric or psychological problems they have or the cognitive problems. I will tell you that judges will reduce those things to carrying out simple routine, repetitive tasks, simple routine, repetitive tasks with minimal contact with the public coworkers and supervisors. So unless you're having psychiatric problems that, that are causing you to be a baker acted or institutionalized, the psychiatric complaints in and of themselves are just not going to be winning the claim . So your doctor's job is to assist in developing the evidence, making sure your story is told accurately and completely. And , um, that's important because the judge is gonna use that R S C to form the basis of the hypothetical. Now I'm gonna go , uh, and , uh, tell you a little story. And this is a story I tell my clients. When we get in front of the judge, there will be you and there will be a vocational evaluator. And that vocational evaluator will never have met you. They'll have read your work history form, they will listen to your testimony, and the judge is going to say something like this, Mr. And Mrs. Ve I want you to assume that this individual who has a prior , uh, work history of , uh, um, know , uh, working in , uh, the software industry , um, <affirmative> ha can sit for , um, six out of eight hours, stand to lift 10, but because of cognitive and physical issues is going to be off task at least 10% of the time. Mr. Or Mrs. Ve , could they go back to that kind of work? Well, the VA is going to say no, because while everything is generally , uh, light to sedentary basis on a hypothetical, the one thing that throws it off is being off task at least 10% of the time. And in that industry, you gotta be a hundred percent on a hundred percent of the time. That question was step four. But now comes the million dollar question. And the million dollar question is, well, Mr. And Mrs. Ve based on that hypothetical, is there other work that this person can do in the mythical not real world national economy and view of their age education skills? And my hypothetical and the VA is going to say, judge, they could work in a laundrymat folding towels all day. Judge, they could work in a room all by themselves addressing envelopes all day. And judge , you know, they could work as , um, a phone solicitor , um, judge, you know, they could even work at the local restaurant putting , um, silverware in that nice cloth napkin. If the judge stops there and your lawyer doesn't ask any questions, you're gonna lose. 'cause that question was step five. But if I say, whoa, whoa , wait a second. I want you to assume that this person , um, can't , uh, engage in postural changes , um, more than just one third of the time. So turning right, left up, down, standing up, they can only at best do that one third at a time. I want you to assume , uh, that they have issues , um, with their hands. Uh, they're having some , uh, problems manipulating things. So they can only do manipulative activity for a third of the time. And, you know, because of their fatigue , um, because of , uh, side effects of medication, they're actually gonna be off task at least 15 to 20% of the time. And, you know, because of all the constellation of their symptoms, they're not going to be able to meet the attendance requirements and they're gonna be missing at least two days of work per month. Now, Mr. And Mrs. Ve as we add these things to the hypothetical, can they, can this hypothetical person do the jobs you identified or any other work in the national economy? And the answer should be no. But this hypothetical is got to be formatted , um, to meet your specific medical conditions and what potentially a judge would find as your restrictions and limitations. And many times I'm taking my hypothetical from not only my experience, but from the residual functional capacity forms that are being , uh, filled up by the doctors . So I'm adding things to the judge's hypothetical, I'm doing my own hypotheticals. And ultimately it comes down to what the judge is going to , uh, make of your credibility and what hypothetical they , uh, um, go with. But I'm also, as many lawyers are setting this up for an appeal, if a judge , um, rules against you. Because many times the vocational issues can be a good fodder for an appeal if a claim gets denied. So we've talked about the five step sequential evaluation and the three stages of a social security case. So how do people like, like I get paid? Well, it's 25% of the back benefits up to a maximum of $7,200. The fee was raised in November of 2022. And it comes from back benefits. So I have an example here on the slide. Um, if in this particular instance the person is disabled as of January 1st, 2022, there's the five month waiting period that ends May 31st. 2022 benefits are paid in May of 2023 at $3,000 a month. 12 times three is 36,000, 20% of that is 9,000. So the fee is capped at $7,200. It's a one-time fee. Now, people can petition for a a , a fee that's higher than the 25% has to be approved by judges. And judges aren't necessarily automatically going to reapp approving a fee request in excess of the maximum fee. Um, there are costs that are , are incurred in cases. Um, some lawyers will advance costs. I don't advance costs . I do ask that they be reimbursed at the end of the case. And costs are basically the cost of getting the medical records. 'cause you can't win without getting the medical records. Um, as I said, it's a one-time fee. So when you get your benefits, you're not gonna be paying or shouldn't be paying your lawyer a monthly fee from those ongoing benefits. If you change a lawyer , uh, um, generally the lawyers will work out the, the fee in entitlement. And that's particularly true if, for example, you have an ERISA disability claim and the disability carrier has said, but we recog you recommend that you use this particular company , um, which I don't recommend , um, but ultimately you choose another social security or risk a disability attorney, then we , I end up dealing with that as, as anybody else would deal with that fee. Um, and many times they'll just waive their fee. Um, so you're not gonna have to pay a double fee. I want to make that clear. The, if there's a fee dispute, generally it's between lawyers and it's addressed generally by lawyers. And rarely does the court get involved because the lawyers will get it resolved. Now, why do you need an attorney? Abraham Lincoln once said, A person who represents himself has a fool for a client. Now, I am a highly specialized lawyer, but if I were to, to need a , a will or an an estate or I was gonna buy a piece of real estate, I would not be representing myself. I wouldn't be doing my own will. I wouldn't be doing my own estate. I wouldn't be doing my own clothing because I don't know anything, even though I'm a lawyer, that's not my area of specialty. You may be the smartest person in your family in your industry, but I assure you that when you are disabled, you don't have either the physical or the cognitive stamina to really do this. Right? And I will tell you, social security is not your friend and they're not in the business of paying benefits. If you think you're gonna , you know, be at the mercy of the judge and the judge is gonna see how disabled you are, that's not gonna happen. The judge is gonna apply the five steps , sequential evaluation over and over and over. So regardless of how disabled you think you are, regardless of how obvious or not obvious it is, you can't count on the Social Security Administration or the judge to do the right thing. The win rate with lawyers representing people is higher. Um, we take them on a contingency basis. So no fee unless we win. And there is no fee. By the way, as we're handling the claim , um, cases, these are very medically and vocationally complex cases and they're very poorly understood by the Social Security Administration. And I'll tell you more about that. And for the most part, as a practical matter, they don't have any protocol for evaluating these cases. Um, and many times, as I've said this , just not the proper case development of the records and the right RFCs, there's not a proper preparation of the client. There's not , um, you gotta have the, a brief written and, you know, you know, a five page brief sounds pretty simple, but in fact it's not because you have to point to the verse and page, if you will, of the medical records to establish that you might need a listing or support the fact that , um, you have restrictions that would preclude you from doing your past relevant work or other work. And of course any representation in the trial . Um , and many times if you show up unrepresented, the judge will suggest strongly that you get an attorney and will continue the hearing until you do that. And of course, you don't know how to cross-examine a vocational evaluator regardless of how many times you've seen a , a , a legal show on tv. So the other thing I talk to my clients about is what's at stake here? What's at stake here are monthly benefits from the end of the waiting period until the retirement age. So if you're getting three, four, you know, $4,000 a month of benefits , um, that's, you know, 36 to $48,000 a year. And even if you're getting a thousand dollars a month, a thousand is a thousand is a thousand, which is better than zero. Um, you also get cost of living adjustment benefits. And , uh, as you, as you may know, there was a huge , uh, increase , uh, in benefits because of the , uh, large cola. And of course, once you become eligible for your Social security disability or S S I benefits, you are getting lifetime medical benefits in the form of Medicare or Medicaid. And that to me, that's a lot at stake , uh, particularly in today's environment. So that's why I think you need to have an attorney. So how about if we take a break and then I'm gonna get into the various medical conditions and we're gonna talk about each one of them , how social security views them, and I'm gonna give you some tips for how I think , uh, they can be one .

Cindy Brown: 45:16

Great , thank you Nancy. Why don't , isn't everybody take a stretch and maybe go to the bathroom, get something to drink because we all need to be drinking . Oh , good . Look , as I said that Nancy was <laugh> . Alright , take a break everyone.

Disability Attorney Nancy L. Cavey: 45:30

Great. Well welcome back everyone. Um, what I'd like to do now is to talk about each of the medical conditions that I deal with this in this particular sphere. Um, and , um, I am obviously not a doctor, but I think it's really important that my clients understand the disease process and that you be represented by a lawyer who understands the nature of the disease, the symptoms, how it impacts your functionality, and how you specifically experience , uh, the dysfunction of the disease so that , um, the appropriate records, medical records, and R f C forms and your testimony is , are properly , uh, developed. So , uh, bear with me if you , uh, are familiar with this, but I wanna kind of use this , uh, description of each of these diseases to kind of set the stage. So let's first talk about autonomic dysfunction. Uh, the autonomic nervous system known as the a n s controls the heart rate, body temperature, breathing rate, digestion and sensation. It's basically the connection between your brain and body parts and your internal organs. And there are two types of autonomic nervous systems. There is the sympathetic , uh, uh, and there is the parasympathetic sands and , uh, pans. Um, sands will stimulate organs like the heart, liver, sweat glands, skin, digestive and urinary system while the pans slow down the, that bodily process. So I'm always interested in hearing from my clients , uh, what problems they might have with their heart, their liver, sweat glands , uh, skin, digestive and urinary issues, and how that may vary depending on the, the nature of their symptoms. And as we all know, it can vary hour to hour , day to day . Um, the , uh, autonomic dysfunction occurs when the nerves of the a n s are damaged and that , uh, can be chronic and it can be worsened over time. Now, what's important about this again is , uh, you know, I keep on banging on the, the , the history, the of the symptoms and functionality and , um, because these problems will generally worsen over time, I think it's really good that you are giving an interval history of the progression of your symptoms. Um, I represent a lot of diabetics. I'm very active in the PD community and there are chronic conditions that also will involve autonomic dysfunctions. Um, and in those cases we're also obviously diagnosed , uh, uh, want our clients to explain the progression of the symptoms from a di diabetic standpoint or from a PD standpoint. But when we have , uh, anon autonomic dysfunction issues, I always want a good history of those symptoms and how they impact functionality. Now, normally what we'll see is dizziness and fainting when standing up notice is orthostatic hypotension. And then we have heart rate issues, we have sweating abnormalities, we have digestive problems, urinary problems, visual issues. I know it can be very difficult to talk about things like urinary or you know, bowel and bladder issues, but that is very important because the need to use a restroom need to be close to a restroom. The frequency with which you have to use a restroom can impact that ability to maintain the pace and production requirements of full-time employment. So I want things like that really well developed in the medical records. Now there a number of different types of autonomic dysfunction. Um, the primary , uh, ones that I will see are pots , uh, and the neurocardiogenic syncope. Uh, I have cases where there are autonomic dysfunction as a result of autoimmune autoimmune disorders, which we'll touch on later. So those are generally the three that, that we see in the context of a , a social security or disability claim. Alright , so let's contrast this with autoimmune disorders. Uh, autonomic disorders are not the same as autoimmune disorders. And autoimmune disorders are not the same as autonomic disorders, but if you have an autoimmune disorder, you can have an autonomic issue. Okay? Um, and so autoimmune diseases arise from an abnormal immune response of the body against substances and tissues that are normally present in your body. Um, localized autoimmune diseases generally affect certain tissues or , uh, body organs. For example, Crohn's diabetes. Um, systemic autoimmune disorder affects body systems and that generally will involve multiple body systems such as MS or rheumatoid arthritis. And a systemic autoimmune disorder is more complex , uh, because of the multi body system involvement. And again, in a social security case, I wanna develop every medical condition that I can to win the claim. Now, what I am seeing in autoimmune disorders, by the way, is a lot of post covid development of autoimmune disorders. Um, I'm also seeing post covid aggravation of preexisting autoimmune disorder, and I'm seeing post covid development of systemic body disorders and autoimmune disorders. So it's a , a really mixed bag that we are seeing with , uh, post covid , uh, issues. Now, again, without getting into , uh, a lot of detail, social security is gonna want to see positive lab work and diagnostic studies that will confirm both , uh, uh, autonomic dysfunction and autoimmune disorders. Um, and generally they are looking for positive lab work and di other objective diagnostic studies to be found in the medical records. Um, let's talk about pots. Um, now that we've sort of set the stage between the difference of autonomic uh , dysfunction and autoimmune dysfunction, I'm gonna go back to the auto autonomic issues. Um, because again, even in the cases where we've got , uh, the autoimmune issues, we are seeing , um, autonomic issues, one of which is pots. So social security does not understand the term pots, they don't understand the symptoms of pots, they don't understand the type and causes of pots. They don't understand excessive heart rate increases in , uh, pots with , uh, particularly in cases where there is , uh, normal cardiac function, if you will. And they don't necessarily get the listings that are potentials in a social security claim. So let's take this word apart. Postural orthostatic tachycardia syndrome. So postural refers to the position of your body. So in your medical records, I would wanna see you giving , um, a history to the physician of problems that you're having with the positioning of your body. 'cause remember, we have to prove you can't even do a sedentary job. And most of the sedentary jobs involve postural issues, turning, twisting, standing , uh, uh, bending, stooping, that sort of thing. Or the static refers to the act of standing up. So what's happening to your body when you stand up? And of course, tachycardia refers to an increase in the heart rate and the syndrome is the group of symptoms, the constellation of symptoms. And I want would like to see in the medical records you basically breaking down your symptoms in terms of postural or the static tachycardia and then any other syndrome symptoms that you have. That's the best way I think, to tell the story, and that's what I'm telling my clients , uh, from the beginning. So SS social Security doesn't get what each of these mean in terms of your symptoms and functionality. So it's up to you to make sure you're explaining that. Now, there are four types of pots. Um, let's talk about neuropathic pots. It's associated with damage to the small nerve fibers that regulate the construction of blood vessels in limbs in the abdomen. And this can cause symptoms of dysfunction and the limbs and the gastroenterological system. And so there is just not, there isn't a listing for pots. So we go searching around for listings that we can try to meet. And that of course is in part based on your symptoms. So we can look at section 11, the neurological listings. Section five, the gastrointestinal listings. Um, there's hydrogen , uh, pots, which is associated with , uh, um, a loss of the , uh, noer , I'm sorry, I can never say this word. Noer , norrine , sorry. That can cause tremors, cold sweats, extremities, migraine headaches, and increase urination. So I'm looking in the medical records for tremors that impacts your ability to use both your hands. Bilateral manual dexterity , um, cold and sweaty extremities. Obviously that would result in environmental restrictions. Migraine headaches can also result in restrictions and limitations because of the functional issues associated with the migraine. Where you'll flatten a cold, dark room and urination obviously is the need to go to the bathroom. There is urological listings, but there aren't any listings for migraines. So as we break down , uh, your symptoms and the type of pots, then we're looking at listings. Uh, hypovolemic pots is associated with low levels of blood that causes weakness and decreased tolerance for activity. And there is no equivalent listing. But again, I'm into symptoms. And then there's secondary pots, which is associated with other conditions such as diabetes, Lyme, lupus, RINs , um, and these can cause pot like symptoms. And additionally we're dealing with symptoms of , uh, the underlying disease. There's no listing for secondary pots. So again, I'm looking at where can I potentially get them. Maybe I can get them in a lupus listing, maybe I can get them in a diabetes listing. Um, so again, four types. Uh, and we're trying to get as close as we can to a listing. Now let's talk about the diagnosis of pots. Um, as you have all unfortunately experienced, not all doctors get pots. In fact, very few of 'em I'm gonna call the traditional mainstream doctors , um, family doctors, even emergency room doctors, neurologists, cardiologists don't always get pots and you'll present and they'll say it's all in your head , uh, or some other things. Um, and so it's really important that you're treating with , uh, being evaluated and treated with a a POTS specialist. Um, what's key for social security is the physical exam. Any blood work, the , uh, standing test or the heads up tilt table test. Now , um, as we know, when you do the positive, when you do the tilt test, what you are looking for is , uh, an abnormal heart rate response to being upright. Your symptoms worsen when upright and you don't develop the , uh, orthostatic hypotension in the first three minutes. Um, social security will pay attention to that, but even if you have a negative tilt test, doesn't mean that they're gonna necessarily question the diagnosis, particularly when there are other tests that are are cooperative of pots . I always wanna make sure that , um, these tests are documented in the medical records. There have been times, quite frankly, when I've had actually had to have a second read on the results of the tilt table test to show in fact that the cardiologist misread it. So again, I'm always looking at the diagnosis. Uh, social security is gonna be looking at the diagnosis. Now, one of the things that is a bit problematic as you know, is that there are similar medical , medical symptoms of similar medical conditions. There's me , c f s, there is fibromyalgia and you will see an overlap of symptoms. And so they are generally looking for a rule out of those medical conditions. Though I've had clients who have all of that, all, all of these conditions in combination. So the key to winning a POTS claim is supportive medical records with your history of symptoms and functionality, objective testing , uh, of the diagnosis, objective testing that supports the R F C , uh, potentially trying to meet the listings , um, figuring out backwards why you can't do your past work. And then making sure that we've got the symptoms and functionality that are true and accurate, but would preclude you from doing that past relevant work. If you're under 50, we have to show that you can't do even sedentary work, that there's been what we call an erosion of your ability to do that , um, because of the need to alternate sitting and standing naps , uh, fatigue issues, concentration issues, pace issues, attendance issues , um, but ultimately to win we have to show basically less than sedentary that you can only do simple routine, repetitive tasks and that the kind of work you can do is what we call unskilled , um, which is basically , um, McDonald level type type work. If you're over 50, we have to show sedentary and no skills. And again, just these , the words I'm using should be clues and keys to you , uh, that you needed a lawyer to represent you in this case because you probably didn't fully understand , um, what we have to prove for P R W or other work. Sedentary unskilled work, transferrable skills, all terms of art in a social security case. So let's talk about ccf . S they don't understand the term me , c f s, they don't understand the symptoms, they don't understand autoimmune issues and they don't understand the potential listings for impairments. So me , C F Ss is a complex medical condition. It can be caused by infections, immune system challenges, stress, and possibly a genetic list, a link rather. Um, I will say to you if there's any good thing that has come out of covid, it is that me CCF s cases are getting much more attention and there's a lot of scientific attention being directed to the Covid virus, which is helping , uh, with the diagnosis and potential treatment of me C F Ss. Um, there is no gold standard test for a diagnosis of me ccf . S it's based on history and physical exam. It's sort of a , a , um, a diagnosis of elimination, much like fibromyalgia was back in the day. Um, what is a primary symptom , uh, drop in activity level along with fatigue that lasts six months? The nature of the fatigue is important. So if you're having fatigue issues, it's the nature of the fatigue issue. It could be that you have unrestful , um, sleep, you have to take naps when you wake up, you feel like you're in a fog. Um, so it's the nature of the fatigue that's important that it in that is being described in your medical records. Um, traditionally you'll see a worsening of me ccf s symptoms after physical or mental activity that wouldn't have caused a problem before the illness. It's known as post exertional malaise. One of the ways that we measure it, particularly in my Eris a disability , uh, cases is with something called a cpet exam , um, a cardiac pulmonary exercise test. Um, and in the right case , um, we'll use that test generally not in a pure social security case. Me c f s is also associated with sleep issues. So those sleep issues should be documented, including, again, the nature of the sleep problems. Whether you are using any kind of A C P A P , how compliant you are. Uh , I know that C P A P is associated with breathing issues, but again, social security tends to associate sleep problems with other sleep disorders and they always jump to the, we wanna know if your person is, you know , uh, using a mask. Um, and in the diagnosis process, this , the diagnosis is also predicated on one of the two following symptoms, problems with thinking and memory and worsening of symptoms when standing or sitting upright back to our orthostatic intolerance. So you can see there's a lot of overlap between these. And when I'm dealing with a case, I'm trying to figure out do I have a , a pure Potts case? Do I have a an autoimmune disorder case? Do I have an me ccf SS case, or do I have a combination of them? Because I wanna be developing the necessary medical evidence and the appropriate residual functional capacity form . M E C F S is seen with other common symptoms, pain and muscle and joints, headaches, digestive issues, irregular heartbeat, muscle weakness, shortness of breath, some of which are consistent with fibromyalgia. Um, now many people with me , c f s, have autoimmune conditions like fibromyalgia , um, and they'll have , uh, pots again, it's not, and I don't mean , uh, autonomic pots, I mean , um, basically autoimmune, autoimmune generated pots. Um, some , someone, for example, who has ms. So again, sorting all of this out is important for social security purposes, because if I have a client who has multiple medical issues or we're not quite clear in the diagnosis, I wanna be arguing as many medical conditions as I can. So the key to winning an E C F SS claim again, are the exam findings and, and symptoms consistent with a diagnosis , uh, the treatment by a specialist. And in all of these cases, I will tell you, if you're just treating with a garden variety physician as opposed to a specialist, that will not help your case. Um, the Social Security Administration and particularly judges expect that you're being seen by an expert. Uh, in an E C F SS case, we, again, in select cases, will do the pulmonary exercise testing, and in select cases we'll do neurocognitive testing that will support the complaints of problems with memory , uh, dysfunction. There is no listing for me , C F Ss . So again, you're not gonna win at step three. Much like pots , you're generally not gonna win at step three. Um, step four and five are the same. Keys can't do past relevant work. Step five under 50, less than sedentary, simple routine, repetitive unskilled work, over 50 sedentary, but no transferrable skills. And again, as I'm listening and reading records, I'm trying to translate , uh, to how I can develop a winning theory to get my clients their benefits based in part on their age. Small fiber neuropathy, again , uh, we see are seeing , uh, increased cases of salt fiber neuropathy, particularly post covid and social security really doesn't get , uh, S F N , um, for the same reasons. They don't understand the terms, the symptoms, the causes, or potential listings. And so again, I think it's helpful to step back. What is small fire fiber neuropathy? It is , uh, a disease, if you will, or neuropathy caused primarily by diabetes. But autoimmune disorders, S'S sclerosis , uh, uh, some neoplastic syndrome diseases, and again, I'm looking for the diagnosis. Um, the symptoms of SS f n include pain and burning in the feet, trunk or arms, electric shock level pain, lightheadedness, blood pressure will drop when sitting or standing up, loss of consciousness, sweating, gastroenterological issues. I am always, when I'm hearing these symptoms of pain and burning in the feet, trunk or arms going to, how does that impact a person's ability to sit? Can they sit six out of eight hours? Do they have to get up? Do they have to move around? What do they do to address this electric shock level pain? Um, uh, are they taking medications like, for example, gabapentin? Uh, and what are the side effects of that medication? Is it working, not working? Does it make them a little slow in , you know , cognitively does it knock them out in terms of, of making them sleepy? So I wanna develop, when I hear those types of things, the impact on a person's ability to sit and certainly their ability to use their hands individually, right hand , left hand, right hand together , or hands together. Why sedentary jobs are based on this, that is the continual use of your hands in a, in a bilateral matter, be it typing, be it, you know, one finger typing, if you will, manipulating things, assembling things, rolling silverware in that nice cloth napkin, holding a pen and writing things. Okay? Now, in small fiber neuropathy, there are , uh, R F C forms , uh, potentially that we've developed, but there's also a listing level impairment at 11.14 14 rather. So you have to have motor function tests, mgs, nerve conduction study tests , scans, that sort of thing. And for those of you who have had EMG and nerve conduction study tests , you know, they're not particularly pleasant tests. Same key, past relevant work, other work. That's the game in these claims. And you always have to be thinking by each medical condition, how do I get a person to less than sedentary if they're under 50 or sedentary if they're 50 or over mast cell activation syndrome, social security doesn't understand it. Uh , they tend, particularly in my experience with judges, they're, they're kind of glossing over it. Um, they think it's sort of a basic allergic reaction, but they don't get the full nature of that reaction. So I'm spending a lot of time in trial with my clients, making sure we're talking about the symptoms , uh, and then talking about the combination, if you will. Um, so , uh, mast cell activation syndrome really wasn't recognized by the C D C before 2017. And it occurs when , um, mast cells, which are allergy cells, responsible for immediate allergic reactions, trigger that reaction or an inflammatory response. And , um, basically the mast cells are secreting certain , uh, uh, chemicals, if you will , uh, that , um, are being , uh, generated or , uh, triggered in response to whatever the particular pathogen is. Um, and , um, what happens is these mediators are, are basically being released too frequently, and they're causing allergic reaction in various body systems, the skin, the nervous system, the cardiovascular, and the digestive system. And too often social security and the judges tend to think that it's just a , a reaction on the skin, when in fact it's a , a multi-system , uh, reaction. And that's why I want that well documented in the medical records and well explained by my clients. So symptoms are chronic fatigue, itching and watering of eyes, nasal problems, shortness of breath, recurrent arrhythmias, low blood pressure, syncope, and pots like symptoms. So many times we're gonna have an overlap, overlap of symptoms, but we may not have, for example, POTS diagnosis. Um, in pots. We don't always have mast cell activation syndrome, though I see them a lot together. They're just not always presenting that way. Now, what I'm also seeing , um, uh, and my colleagues are seeing , uh, are OSE syndrome pots and , um, the mast cell , um, activation syndrome , uh, occurring together , um, ERs Danlos , as I'll talk about in a moment, is a congenital disease, but for some reason , uh, particularly post covid , I'm seeing a presentation of of, of an activation of Eller Danlos syndrome. And certainly we're seeing pots , uh, and um, M C A S. And so it , it's not uncommon to see it with autoimmune disorders, but I'm also seeing it in presentation , uh, or a combination , uh, with genetic conditions. Um, there is no listing. Uh, the applicable listings can include an immune listing, 1406 if we've got two body systems involved. Um, one system moderately involved, and at least two of the following, severe fatigue, fever, malaise or involuntary , uh, weight loss. Now, there can be other applicable listings based on other involved body systems , but when I have , uh, mast cell, I'm looking at listing 14.06. Again, what's the key? It's gonna be those medical records with symptoms and system involvement. So you should be thinking about, okay, I have skin issues here, here are what they are, I have digestive issues, here are what they are. Then I have everything else. Here are those symptoms. This is how it impacts my ability to function. So we're looking to break down in detail each one of these medical conditions in terms of symptoms and functionality, identifying the right R F C form and then trying to work it in, if possible, to a listing c ovid 19 . Um, there are lots of things that social security does not get about covid. I just tried one of the first Covid cases in Florida in April, won it. Um, but before the hearing got started, and in this case I had had five different kinds of R F C forms, when before we went on the record, the judge said, look, social security has no position paper on this. They've given us no direction as to how we're supposed to evaluate this condition. What do you think I should do? And I said to him, I said, look, COVID clearly causes immunological issues, so let's evaluate any immunological issues or diagnoses that we think exist . It causes pulmonary issues. So if my client's got pulmonary issues, let's evaluate those. They've got cardiac issues, they've got digestive issues. So basically I suggested the judge that we back into this based on either the diagnosis or the system involvement , um, which is why I had the R F C forms. Ultimately, the judge agreed with me , um, and we, and we won this case. Um, so right now I'm trying to do a lot of education of the judges in my memo of law or in my opening statement about how they should be evaluating the Covid case or covid complicated , um, uh, long-term Covid case. Um, now I will tell you they wanna see a a c Ovid 19 diagnosis, and that can be hard because particularly in the beginning , uh, there were a lot of false positives. Uh, I can sometimes get around that based on , uh, sort of a , a post , um, c Ovid 19 , um, analysis of the medical records. And what, what I mean by that, when you look at , uh, the history that the person gives about their symptoms, how those symptoms progressed, and then what post covid in quotes , uh, body systems were involved. But let's say , um, I, I have a client , um, who has significant pulmonary issues. We obviously had to submit documentation regarding the underlying covid diagnosis, but we were submitting pulmonary function tests to document the , the , uh, complications that he was having from a pulmonary standpoint. So again, you , you, you gotta look individually and , uh, collectively at these medical conditions and , um, develop the right , uh, medical , uh, history and R S C form. I will tell you, I think that that Potts cases, in covid cases do take more preparation of the client , um, because there are just potentially so many more symptoms. In other cases, I have a lot of overlap of symptoms. So when I've got overlapping conditions, I'm spending time with my clients trying to help them sort out what the disabling symptoms are. When I have combination cases, I try to silo them to begin with, if you will, and then in the medical records and in testimony, develop how each works individually and then in combination. Okay, LER Danlos syndrome , um, they don't necessarily get what it is. Um, listings are a little easier for them, but it , um, it clearly is not an autoimmune disorder. It's a genetic disorder. It impacts the collagen, and as a result, that impacts your skin, your blood vessels, your joints. It can result in hypermobility and over flexible joints that results in dislocation any joint, it can potentially move beyond its normal range of motion. So , um, I just tried a case last week , uh, which , which is an e d s case. Uh, and this person would have chronically dislocated , um, ribs. She would just roll over and she would also have dislocated , um, joints in her fingers, and she would have , uh, joint , uh, dislocation issues with her hips. So obviously, I'm talking , uh, and developing the medical records and the R F C forms to address the finger issue manipulation. Uh, we're dealing with the, the ribs because that deals with postural issues , um, hip, the ability to , um, to sit. So again , um, not to be repetitive. It really is important that we're addressing those kinds of symptoms that would impact your ability to do even a sedentary job . Um, the diagnosis is made using the Brighton score test and the nature of your symptoms. Social security's gonna wanna see that. They're gonna wanna see this hope hypermobility subluxation and injuries caused by subluxation. There's no e d s listing, but as you can see here , uh, there are at least six potential listings for an e d s claim. And the key to winning again is the test, the Brighton score, testing the family history of e D s, the development of the symptoms, examples of dislocations and injuries. And in this case, I do use family or friend statements more readily and photos and video because it's hard to fake a , you know, a dislocated or subluxated , uh, limb. So I've given you a lot of information. Uh, hopefully you found this educational. Um, I have written a lot of books on social security, and I do a lot of disease specific posts and, and webpages , um, that are available for you. Um, I do do an ERISA podcast called Winning Isn't Easy, and I do do , uh, disease segments. I've done , uh, a whole episode on pots, by the way. Um, it's from the perspective of an ERISA disability claim, but I think it's also helpful for anyone who has a Social Security claim .