Appropriate Treatment for Your Medical Conditions is Crucial for Your Disability Case

Seems like an obvious statement, right? Well surprisingly there are many Social Security Disability claimants who are not receiving sufficient treatment for their conditions. Not only does a person benefit by having sufficient health treatment but his disability case will benefit, also.

A common misconception is that the main medical condition troubling a claimant should be the only condition given focus to in the disability claim. Of course, some people only have one major illness or condition that causes a severe impairment. However, many claimants have other medical conditions that need treated and included in the disability claim.

Here in Ohio, initial claims for disability are decided at the office of Opportunities for Ohioans with Disabilities (OOD). All states have a similar departments of disability determination that makes initial decisions on SSA disability claims. The OOD is generally good about spotting possible additional conditions to the ones the claimant listed on her claim application. Often the OOD adjudicator working on the case will contact the advocate or the claimant to discuss these other conditions and if they need to be looked further into. This does not always happen, though. A good advocate should try and uncover all possible conditions her clients may suffer from, but sometimes these other conditions just get missed. For example, Client A comes to an intake appointment with his advocate and says his COPD is severe and he can no longer work. While discussing his medical history he is adamant his COPD is the only thing bothering him. Then, once the case goes to OOD, the adjudicator calls the advocate to inform her that according to medical records, this client suffered a major back injury requiring surgery. Despite surgery, the client has permanent nerve damage from this back injury. Well, the Client A did not think to tell his advocate because the injury was 20 years ago. He still has moderate to severe pain and suffers from nerve damage but since there was nothing more that could be done he learned to live with it. The COPD may have been enough to establish disability. However, if the COPD despite being severe, falls below the standards for disability he may be denied disability. The fact he is status post back surgery that offered little relief may be enough to tip the scale in his favor. No matter whether remote or seemingly minor, all conditions should be reported to SSA.

Reporting the conditions to SSA is not enought, though. Not everyone's insurance is very good and not everyone can see all the physicians that would benefit her. For one's one good she should report all her symptoms to her main physician so they can be addressed. And if all the conditions are being addressed the disability case will be better supported with good evidence of the claimant's conditions.

Another issue is a claimant not being compliant with his doctor's recommendations for treatment, medications, procedures, etc. Nobody should be forced to undergo treatment they do not wish to. If a person has had a treatment in the past that failed, that can easily be explained. However, if a claimant chooses not to be compliant with treatment to at least see if his condition is relieved, it may hinder a claim for disability.

Some uninsured people are unable to access a marketplace plan or be covered by Medicaid and cannot obtain treatment. Most areas have a free or very low-cost clinic system where basic treatment can be received. It may not be the best or the fastest but some attention to one's medical conditions is better than no attention.

SSA can send a claimant to physical and mental health examinations paid for by SSA. This can be done when a person has no current treatment for an ongoing condition, or lack of treatment. Unfortunately, SSA can only give so much weight if any, to the opinions of a nurse practitioner or licensed counselors that a claimant is seeing on his own. SSA may send a claimant for a formal diagnosis to a state doctor to supplement opinions of nurse practitioners and licensed counselors.

There are potential problems with these exams SSA sends a claimant to. These physicians only examine the claimant one time and may or may not have been provided with the existing history of the claimant's condition. Many of these doctors are compassionate and professional healthcare providers and strive to conduct a thorough examination and give the most accurate assessment, possible. There are state physicians that do not conduct a thorough or proper exam. Despite findings to the contrary they may also provide SSA with feedback about the claimant that she thinks SSA wants to hear. In other words, they give a less than truthful assessment. On the other hand, a state physician’s report may be supportive of the claim and the decision makers at SSA decide to disregard or give less weight to these opinions.

It is important to try and establish and maintain the best healthcare (both mental and physical) as possible. An advocate can assist the claimant in obtaining treatment and should be willing to help her clients locate accessible health care.

Feel free to comment or ask questions!

April L. Roberts, EJD EDPNA

april@aaria.org www.aaria.org

©2017 April L. Roberts and Aaria Consulting, LLC. All Rights Reserved.