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Leading Causes of Disability


30% of all Americans will become disabled between the ages of 35 – 65 with 375,000 becoming disabled annually. Many illness and injuries are responsible for causing disability.

Surprisingly, the number one cause of disability is mental illness (depression, anxiety, bipolar illness, schizophrenia, etc.)  The second leading cause of disability is musculoskeletal problems (back, neck, upper/lower extremity conditions). The third leading cause is arthritis (rheumatoid, osteo, and other connective tissue disorders). Following these, other leading causes of disability include cancer, heart disease, chronic respiratory disease (COPD, asthma, etc.), nervous system disorders (MS, Parkinson’s, etc.), digestive disorders (Crohn’s disease, inflammatory bowel disease, etc.) and diabetes (rising quickly due to obesity epidemic although obesity in and of itself is rarely disabling).

Much lower on the list are accidents and strokes, although the disability caused by these events can be quite severe in many cases. Fortunately, persons focusing more on their health and taking care of themselves has reduced the number of strokes and heart attacks in general.  Also, awareness of the onset of these medical conditions has resulted in persons seeking immediate medical assistance, thus reducing their risk of disability due to delay in treatment.

With the reduction in physical labor being undertaken in this country, the number of work-related accident claims has been decreasing as well as claims resulting from “worn out” workers who engaged in long careers requiring physical exertion.

The leading conditions for making short term disability are cancer and pregnancy. Obviously, injuries and accidents are cause for short term disability claims as well, especially when restorative surgery is required.  Although, advances in motor vehicle safety systems has been instrumental in preventing much more serious injuries resulting from motor vehicle accidents.

In general, causes of disability are associated with an increasingly aging U.S. workforce.  Fortunately, medical advances have been successful in returning many persons back to work from otherwise previously permanently disabling conditions.  The best example of this is the successful treatment of HIV/AIDS with an array of medications. Further, changes in the perception of disabled persons performing work have changed which has allowed persons with physical and developmental disabilities to maintain employment.

What does this cost?  For example, Unum paid $3.8B in disability claims in 2017. It received 425,000 claims during that time period.

Posted in General Disability Issues | Tagged , , , |


The Social Security Administration 2018 Agenda

SSA 2018

As a matter of background, the Social Security Administration (SSA) employs 62,000 federal and 16,000 state workers across the United States and its territories.

SSA is hoping to improve service through several measures. It is hoping to expand its customer service model through its website by allowing appeal of non-disability matters over the Internet. As part of this, SSA will be rolling out an internet chat help service. By doing so, it is hoping to achieve 25 million transactions each year.

SSA also hopes to expand video service at both convenient and remote sites including hospitals, libraries, tribal centers, and homeless shelters. This may include the addition of judge-only hearing sites which may partner with other governmental agencies providing administrative review hearings.

Other measures being undertaken to address the severe case hearing backlog include developing an occupational information system, developing a disability case processing system, and using health information technology to assist in expediting disability decisions. No specifics concerning these aspirational measures were discussed.

SSA has announced new compassionate (fast track) allowances for the following conditions: fibrolamellar cancer, megacytis microcolon intestinal hypoperistalsis syndrome, megalencephaly capillary malformation syndrome, superficial siderosis of the central nervous system, and tetrasomy. In the many thousands of cases done by this firm constituting nearly fifty combined years of Social Security work, we have never had a client with any of these diagnoses.

SSA is enhancing its Electronic Claims Analysis Tool (eCAT) which will guide adjudicators through the sequential evaluation process for determining disability. This system costs about $31M annually to operate and maintain. It is being rolled out on an incremental basis.

The Office of Inspector General (OIG) surveyed users of eCAT and found that only 58% of users were satisfied with using the system with 28% expressing strong dissatisfaction with the system. This dissatisfaction has affected the adoption rate of use of this software. Problems with eCAT include the inability to support multiple printers (with persons in one office having to share a single printer to use this system), need to workaround the system in areas that it does not support, and the inability to efficiently manage caseloads using the system.

Unfortunately, eCAT has not been implemented for the purpose of undertaking continuing disability reviews. This is of pressing importance as the OIG has estimated that 1.1M SSI recipients (1 in 8 recipients) had not had a redetermination of their disabled status in more than 10 years. It estimated that this failure to review has resulted in a overpayments of approximately $381.5M.

SSA discusses that it wishes to improve employment support outreach to targeted working-age beneficiaries. Turning this objective into action has not happened as this has resulted in mailing notices to 35,000 new beneficiaries each month with no follow-up or other contact.

Similarly, SSA states that it is working to build a model workforce to deliver quality service. Currently, SSA is losing far more employees that it is hiring at a time when increasing numbers of disability and retirement claims are being made. The employment losses stem from older workers retiring from SSA, resulting in a loss of institutional knowledge (“brain drain”). New employees require lengthy training until their productivity nears the levels of these experienced employees. To aid in this, SSA has started mentoring partnerships. In its efforts to develop leaders, SSA has instituted several leadership development programs.

Posted in Social Security, Social Security Administration, SSA | Tagged , , |


Bad Things Still Happening at the Social Security Administration (June 2018)


The Social Security Administration (SSA) is facing problems from many sides. As 10,000 persons in the U.S. turn 65 each day, SSA is meeting the challenge by reducing access and services. It has closed 125 field offices since 2000. Recent Inspector General reports have criticized high claim processing times, below average staffing levels, low morale, difficulties with telework, and quality of staff work.

Most concerning of all is that SSA has had to tap into its reserves, the infamous $3T SSA Trust Fund, for the first time since 1982, which is three years sooner than anticipated due to lowered economic growth projections. The current estimates reveal that the Trust Fund is due to be depleted by 2034 while Medicare will be depleted earlier in 2026. Replenishing the fund is problematic as the number of workers supporting a Social Security beneficiary has declined from 3.3 in 2007 to 2.8 today. This is further affected by reduced revenues resulting from the tax cuts effectuated this year.

As a reminder, if SSA becomes insolvent, it remains legislatively obligated to pay scheduled benefits at a rate of 79%. As an aside, the cost of administering the SSA program is only 0.7% of total expenditures.

A sample of 200 beneficiary payments in a study by the Office of the Inspector General (OIG) in May 2018, found that SSA has incorrectly paid 77 beneficiaries almost $1.3M. From this, the OIG estimates that SSA has paid over $571M to over 35,000 beneficiaries. Worse, leading causes of improper payments have not seen significant improvement or corrective actions despite multiple OIG studies pointing out the deficiencies. This has resulted in deficiency dollars of over $1B in SSI payments in both 2015 and 2016.

A Workload Review of the Atlanta and New York Regions Office of Hearings Operations in May 2018 by the OIG revealed that high average processing times resulted from below-average staffing levels (especially with losing senior staffers), low morale, issues with telework (availability, allocation, duties which can be performed), problems with dealing with claimant representatives, difficulty scheduling expert witnesses, large numbers of supplemental hearings and postponements, insufficient decision writers, and information technology problems.

Workers interviewed cited problems including office micromanagement, goals not agreeing with actual capabilities, negative messaging/tone, lack of managerial support, insufficient staff (understaffing at 25 of 37 Atlanta area hearing offices), excessive pressure/overwork, lack of career development opportunities, and frequent changes implemented with little notice or input.

Managers interviewed cited problems including no effective mechanism to hold staff accountable for poor work quality, low productivity, or mistakes.

Criticisms concerning claimant representatives included:

  • Not knowing about their client’s file and being unprepared for the hearing, which then often results in a supplemental hearing, therefore increasing processing time;
  • Having little availability to schedule the hearing;
  • Not communicating with their client;
  • Not working with their client to obtain necessary evidence for the file; and
  • Submitting evidence shortly before the hearing, which often causes the Administrative Law Judge (ALJ) to delay the hearing to review the new evidence.

Criticism of ALJs include:

  • Adversarial relationship between ALJ Union and management;
  • Not providing adequate instruction for decision writers;
  • Not issuing enough decisions (500 – 700 decisions expected per year);
  • Not moving cases out of judge-controlled statuses;
  • Ordering too many supplemental hearings and granting too many postponements; and
  • Over-developing the claimant record and ordering unnecessary evidence.

ALJs cited complaints including:

  • Difficulty scheduling claimant representatives;
  • Claimant representatives submitting late evidence;
  • Uncommunicative claimants or failing to submit evidence; and
  • Claimants not having representation at time of hearing.

Information technology (IT) problems at hearing offices include:

  • IT support staff unavailable;
  • Broken computers;
  • Broken remote site equipment;
  • Inability to access case processing management system; and
  • Broken video equipment in hearing offices.

The OIG 2017 Auditor’s Report set forth additional deficiencies in need of correction, including:

  • IT deficiencies in access and configuration management with no controls to ensure SSA employees comply with existing directives, policies, and procedures for these items; and
  • Failure to properly reconcile accounts receivable to the general ledger and including detailed listing of these with need for updated training and IT system functionality in this regard.

On the only somewhat bright side, by April 2018, SSA had reduced the hearing backlog to under a million cases (968,000).

Even with this slight glimmer of hope, the overwhelming litany of problems at SSA is daunting and will not be resolved in the near distant future.

Posted in Social Security, Social Security Administration, SSA | Tagged , , |


Social Security Administration Customer Service Problems (2017)


If you thought it was difficult to get customer service assistance at a retail establishment, try your luck at acquiring help at a Social Security Administration (SSA) field office. If you attempt this, then you will find the service at the mall to be extraordinarily expedient in comparison to SSA. Of course, the important difference is that you have already paid in your hard-earned tax dollars to SSA in advance in order to receive poor service. This makes the current situation all the more galling.

The February, 2018, the Office of the Inspector General issued its Audit Report concerning wait times experienced by customers at SSA’s field offices. In Fiscal Year 2016, there were over 22,000 visit to SSA field offices. 1,000 of these visitors waited longer than 6 hours for assistance with 126 visitors waiting longer than 7 hours.

Although the number of customers visiting field offices decreased by 1.5M between 2016 and 2017, assistance wait times have increased. Some specific assistance times include the following:

  • Original or replacement SSNs = 17 minutes
  • New SSD claim = 130 minutes
  • New retirement claim = 79 minutes
  • SSI claim = 101 minutes

Although wait times are less for persons making advance appointments with SSA, persons with appointments still experience wait times of more than one hour.

SSA has sought to explain these problems. It states that it has experienced a three year hiring freeze because of lower-than-expected government funding. During that time, SSA lost 2,973 employees with most of these being experienced workers causing an even greater loss of institutional knowledge. In 2011, SSA began closing field offices. In March, 2015, it shortened work hours at the remaining field offices.

To assist with walk-in customer volume and wait times, some offices are employing self-service kiosks for replacing SSN cards, appealing SSD/SSI denials, requesting retirement benefit estimate statements, and applying for disability, retirement, and Medicare. As of 2/18, there were only 1,929 kiosks in 834 field offices.

What is not mentioned in this report is that most customers require customer assistance to use the kiosks which, again, results in delays to other customers waiting for assistance in matters which cannot be transacted on the kiosks. [This was learned from an individual who worked for SSA in this capacity during 2015 – 2016. This is made worse when the one floating kiosk assisting cannot help persons speaking other languages.]

As there seems to be no relief for the current funding situation, customers can only expect increasing wait times given the impending retirement of experienced personnel over the ensuing years as the Baby Boomer generation moves into retirement.

Posted in Long Term Disability, SSA | Tagged , , , , |



Sick Person

It is well known that many physical conditions cause a loss in cognition.

Breast Cancer

Cognitive function is a multidimensional concept that includes attention, concentration, learning, memory, problem-solving ability, visuospatial abilities, mental flexibility, psychomotor efficiency, and manual dexterity. Cognitive impairment has long been associated with adjuvant therapy for breast cancer may be diffuse, affecting all of these processes and may persist for years. The most frequently reported deficits are difficulties with attention and concentration, learning new information, and recalling recently learned information (affecting patients in the range of 26 – 44% of patients). No specific domain of cognitive function has been identified as being more impaired than others as a result of chemotherapy, being a global pattern of dysfunction. Schagen, SB, et al. Cognitive dysfunction and chemotherapy: Neuropsychological findings in perspective. Clin Breast Can. December, 2002; 3(Suppl 3): S100 – S108. The mechanism for cognitive impairment function has not been identified and may be multifactorial and have not included any measures of such variables as fever, depression, anxiety, additional medication, etc. The incidence and severity has not been well documented. Bender, CM, et al. Cognitive function and reproductive hormones in adjuvant therapy for Breast Cancer: A critical review. J Pain Sympt Manage. May, 2001; 21(5): 407 – 24.

A large percentage of patients (31 – 75%) receiving adjuvant postoperative chemotherapy suffered cognitive impairment including attention, mental flexibility, speed of information processing, visual memory, and motor function. The cognitive impairment was not affected by or associated with anxiety, depression, or fatigue. Schagen, SB, et al. Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer. 1999; 85: 640 – 50; Brezden, DB, et al. Cognitive function in breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol. July, 2000; 18(14): 2695 – 2701; Ahles, TA, et al. Breast cancer chemotherapy-related cognitive dysfunction. Clin Breast Can. December, 2002; 3(Suppl 3): S84 – S90; Schagen, SB, et al. Cognitive dysfunction and chemotherapy: Neuropsychological findings in perspective. Clin Breast Can. December, 2002; 3(Suppl 3): S100 – S108. This cognitive function can continue in patients being treatment with tamoxifen. Paganini-Hill, A and Clark, LJ. Preliminary assessment of cognitive function in breast cancer patients treated with tamoxifen. Breast Can Res Treat. 2000; 64: 165 – 76. The cognitive deficit can have a late onset. Schagen, SB, et al. Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer. 1999; 85: 640 – 50. Only 50% of affected patients show cognitive improvement one year post therapy. Wefel, JS, et al. The cognitive sequelae of standard-dose adjuvant chemotherapy in women with breast carcinoma: Results of a prospective, randomized, longitudinal trial. Cancer. 2004; 100: 2292 – 9. This impairment may last up to two years following treatment and will show improvement in most cases four years following treatment. Ahles, A, et al. Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. J Clin Oncol. January 15, 2002; 20(2): 485 – 93; Schagen, SB, et al. Late effects of adjuvant chemotherapy on cognitive function: A follow-up study in breast cancer patients. Ann Oncol. 2002; 13: 1387 – 97. This deficit has been found to last up to 10 years following chemotherapy treatment, occurring in 39% of patients. Ahles, TA, et al. Breast cancer chemotherapy-related cognitive dysfunction. Clin Breast Can. December, 2002; 3(Suppl 3): S84 – S90. Once the onset of the deficit has occurred, it does not worsen over time. Schagen, SB, et al. Cognitive dysfunction and chemotherapy: Neuropsychological findings in perspective. Clin Breast Can. December, 2002; 3(Suppl 3): S100 – S108.

There has been no pattern of mental fatigue and reduced motivation found during testing following adjuvant therapy. DeJong, N, et al. Course of mental fatigue and motivation in breast cancer patients receiving adjuvant chemotherapy. Ann Oncol. 2005; 16: 372 – 82.

Even minimal and subtle cognitive deficits may be profoundly and unacceptably disturbing in a patient’s quality of life following adjuvant treatment for breast cancer. Olin, JJ. Cognitive function after systemic therapy for breast cancer. Oncology. May, 2001; 613 – 624

Cerebellar Ataxia

The relationship between the cerebellum and the frontal cortex is also poorly understood. Another study has demonstrated that patients with idiopathic cerebellar degeneration exhibit slowing of cognitive information processing. These findings suggest that the cognitive slowing may be due to a disruption of neural circuits between the cerebellum and the frontal cortex. Kawabata, TH, et al. Prolonged P3 latency and decreased brain perfusion in cerebellar degeneration. Acta Neurol Scand. 1999; 100: 310 – 316. These patients have been found to suffer from significant deficits in verbal and nonverbal intelligence, verbal associative learning, and visuospatial skills. Subclinical involvement of auditory and somatosensory pathways at the level of the brainstem were also detected. These deficits were not readily explained by associated motor impairment. Akshoomoff, NA, et al. Contribution of the cerebellum to neuropsychological functioning: Evidence from a case of cerebellar degenerative disorder. Neuropsychologia. 1991; 30(4): 315 – 328.

Chronic Pain

Neurocognitive difficulties are often reported by chronic pain patients. Greater pain severity has been associated with poorer neurocognitive performance in several studies. Memory functions have been found to be affected in distressed chronic pain patients. Unfortunately, there is little evidence concerning the relation between the variables of pain severity, psychological distress, and neurocognitive performance. Iezzi, T, et al. Predictors of neurocognitive performance in chronic pain patients. Int J Behav Med. 2004; 11(1): 56 – 61.

A physician should attend to the psychological impairments resulting from chronic pain syndrome and specify functional limitations when limitations of attention, concentration, or the inability to tolerate environmental stress and distraction might make the individual ineffectual or a risk to others. Ashburn, MA and Rice, LJ, eds. The Management of Pain. (Churchill Livingstone 1998): 67.
Functional pain limitations include measures of a patient’s concentration and cognitive processes, activities of living, emotional status, and functional abilities, as perceived by the patient and physicians. Functional performance evaluation in patients with chronic pain. Evaluation and Treatment of Chronic Pain. Aronoff, GM, ed., 3d., (Williams & Wikins 1998): 603 – 615; Rucker, KS. Standardization of chronic pain assessment: A multiperspective approach. Clin J Pain. 1996; 12: 94 – 110.


Overall, the natural course of neurocognitive disorders associated with HIV infection remains poorly understood. neuropsychological testing is effective in evaluating suspected HIV neurocognitive disorders by quantifying the severity of cognitive impairment and defining the patterns of involvement. Gendelman, H., et al, eds. The Neurology of AIDS. (International Thomson Publishing 1998).

The neurocognitive effects of HIV have been studied extensively. The two levels of neurocognitive impairment are mild (deficits in two or more cognitive areas that interfere at least mildly with daily functioning) and dementia (severe neurocognitive which interferes markedly with daily functioning to the point that diagnosed persons are typically unable to work and may not be able to care for themselves). There is criterion overlap between these two types of neurocognitive impairment with no bright line test for differentiation. In general, cognitive impairment is characterized by mental slowness, forgetfulness, and poor concentration accompanied by behavioral changes including apathy, lethargy and diminished spontaneity. Gendelman, H., et al, eds. The Neurology of AIDS. (International Thomson Publishing 1998) These two levels of cognitive impairment are experienced by 30% of symptomatic HIV patients. Unfortunate consequences of cognitive deficits include the inability to operate a motor vehicle and adhere to a medication regimen. McArthur, JC, et al. Human immunodeficiency virus-associated dementia: An evolving disease. J NeuroVirology. 2003; 9: 205 – 221; Benaslem, MK, and Berger, JR. HIV and the Central Nervous System. Comp Ther. 2002; 28(1): 23 – 33. Most HIV-infected patients do not meet the criteria for diagnosis of dementia. The mild form of neurocognitive impairment can cause deficits which interfere with the ability of patients to complete normal activities of daily living as well as negatively impact on treatment adherence. Oaul, RH, et al. Neurocognitive manifestations of human immunodeficiency virus. CNS Spectrums. December, 2002; 7(12): 860 – 6.

There have no studies concerning the effect of neurocognitive deficits on a person’s ability to maintain employment. Since a person may remained employed, but may be working at a less demanding and less remunerative occupation makes such studies difficult. Further, there has been little research concerning the effects of neurocognitive deficits on a patient’s quality of life although these deficits have been associated with a higher rate of mortality. Gendelman, H., et al, eds. The Neurology of AIDS. (International Thomson Publishing 1998). In general, it has been found that cognitive impairment in any cognitive domain is associated with a poor quality of life. Affected persons with impaired executive and attentional functions and slowed processing speed are less able to employ effective coping strategies to manage stressors. It has been further revealed that self-reported measures of cognitive functioning correlate significantly with objective measures of cognitive functions. Tozzi, V, et al. Neurocogntive performance and quality of life in patients with HIV infection. AID Res and Human Retroviruses. 2003; 19(8): 643 – 52.

Neuropsychological testing is effective in evaluating suspected HIV neurocognitive disorders by quantifying the severity of cognitive impairment and defining the patterns of involvement. This testing allows for determination of whether a person suffers from mild neurocognitive disorder rather than HIV dementia. Gendelman, H., et al, eds. The Neurology of AIDS. (International Thomson Publishing 1998). Neuropsychologic functioning has been demonstrated to be independent of depression. Milliken, CP, et al. Fatigue in HIV/AIDS is associated with depression and subjective neurocognitive complaints but not neuropsychological functioning. J Clin Exp Neuropsychol. 2003; 25(3): 201 – 15.

Fatigue and depression do not appear to affect neuropsychological functioning in HIV/AIDS patients. Millikin, CP, et al. Fatigue in HIV/AIDS is associated with depression and subjective neurocognitive complaints but no neuropsychological functioning. J Clin Exp Neurpsych. 2003; 25(2): 201 – 215.


Neuropathic symptoms in hypothyroidism are also common, occurring in 40 – 60% of patients. Neuropathic symptoms include paresthesias painful dyesthesias. Patients may have symptoms of mononeuropathy, polyneuropathy, and cranial nerve neuropathy. One-third of patients have gait unsteadiness. This may include gait ataxia and poor coordination. In rare cases, dyarthric speech has occurred. Neurocognitive impairment may be a prominent feature of hypothyroidism, especially in older patients. This will include slowness in comprehension, diminished attention span, poor recent memory, difficulty with word fluency, and impairment abstract thinking. Even with treatment, resolution of cognitive impairment is slow and can be incomplete. Id.; Whybrow, PC and Bauer, M. Behavioral and psychiatric aspects of hypothyroidism. Braverman, LE and Utiger, RD, eds. The Thyroid: A Fundamental and Clinical Text. 9th ed. (Lippincott, Williams & Wilkins 2005): 842 – 9.

This general decline in cognitive and behavioral function is an integral part of hypometabolic state. The neuropsychiatric symptoms suffered by patients with hypothyroidism may lead to an incorrect diagnosis of a depressive state. Many of these patients will exhibit melancholic symptoms such as crying, loss of appetite, insomnia, and diminished interest in and responsiveness to others. Other patients become fearful, suspicious, and delusional. Although depressed mood seems to predominate, specific mental state and thought content varies with the individual patient. Cognitive changes such as alterations in attention, concentration, perception, and speed of thought appear to be the most common clinical manifestations. Objective psychological testing has revealed impairments in cognitive function including deficits in memory and learning, attention, visuoperceptual and construction skills, and psychomotor slowing. There is a high incidence of hypothyroidism in patients diagnosed with bipolar (manic-depressive) illness. Brain scan imaging techniques are being developed in an effort to better delineate this condition. Whybrow, PC and Bauer, M. Behavioral and psychiatric aspects of hypothyroidism. Braverman, LE and Utiger, RD, eds. The Thyroid: A Fundamental and Clinical Text. 9th ed. (Lippincott, Williams & Wilkins 2005): 842 – 9; Bauer, M, et al. Thyroid, brain and mood modulation in affective disorders: Insights from molecular research and functional brain imaging. Pharmacopsychiatry. 2003; 36 Suppl 3: S215 – S221.

The neuropsychiatric effect is so pronounced that it has been recorded in subclinical hypothyroid patients in a study of elderly patients. This lesser version of hypothyroidism is believed to be a predisposing factor for depression, cognitive impairment, and dementia. Davis, JD, et al. Cognitive and neuropsychiatric aspects of subclinical hypothyroidism: Significant in the elderly. Curr Psych Rep. 2003; 5: 384 – 90.

Multiple Sclerosis

Prevalence of cognitive loss is present in as high as 50% of MS patients. The cognitive deficits are typically not appreciated or noted by treating physicians and may occur early in the disease course. Tasks affected include recently memory, sustained attention, speed of cognitive processing, and conceptual reasoning. Changes in neurologic disability are poor predictors of the degree of cognitive dysfunction. Some MRIs revealing cerebral damaged may be positively correlated with the severity of cognitive loss. Some patients experiencing cognitive loss have trouble accepting this problem. In many cases, they will not inform their treatment providers of the problem. Schiffer, RB. Cognitive Loss. In Multiple Sclerosis in Clinical Practice. van den Noort, S, and Holland, NJ, eds. (Demos Medical Publishing 1999): 99 – 105. Also affected are the following processes: learning, recall of new information, speed of information processing, visualspatial abilities, executive functions (reasoning, problem solving, and planning), as well as timed performance. Poor memory is a common complaint among MS patients. Joy, JE, and Johnston, Jr., RB, eds. Multiple Sclerosis: Current status and strategies for the future. (National Academy Press 2001): 115 – 117. See also. LaRocca, NG. In Multiple Sclerosis” Diagnosis, medical management and rehabilitation. Burks, JS, and Johnson, KP, eds. (Demos Medical Publ. 2000: 405 – 423.


Emotional distress does not have a positive association with cognitive function. In addition, disease activity has not been associated with cognitive function although fatigue measures have demonstrated a significant relationship. Denburg, SN, Carbotte, RM, and Denburt, JA. Psychological aspects of systemic lupus erythematosus: Cognitive function, mood, and self-report. J Rheumatol. 1997; 27: 998 – 1003.

As many as 66% of lupus patients report cognitive deficits which are often associated with information processing and working memory, but can also affect immediate memory or recall, fluency, attention, speed of information processing, psychomotor speed. The cognitive dysfunction demonstrated falls into the “subcortical” pattern similar to that suffered by multiple sclerosis patients. Shucard, JL, et al. Working memory and processing speed deficits in systemic lupus erythematosus as measured by the paced auditory serial addition test. J Int’l Neuropsyh Soc. 2004; 10: 35 – 45.

Postpump Syndrome

There is substantial medical authority which states that many persons suffer from cognitive impairment following CABG surgery. Even after a substantial period of recovery, there remain a proportion of patients who suffer cognitive decline which sufficiently disabled them from returning to employment. Dijk, D.V., M.D., et al. Cognitive Outcome after Off-Pump and On-Pump Coronary Artery Bypass Graft Surgery. Journal of the American Medical Association (JAMA). 2002; 287: 1405 – 12; Newman, Mark F., et al. Longitudinal Assessment of Neurocognitve Function after Coronary Artery Bypass Surgery. New England Journal of Medicine. 2001; 344: 395 – 402. This testing revealed that over 30% of CABG patients suffered cognitive decline 12 months after surgery. Unfortunately, the final numbers were reduced since many patients (12%) did not undergo follow-up testing after the original 3 month testing period. Id. at 1409. Cognitive decline was defined as a 23% decline in performance at the 3 month testing mark. Id. at 1311. A similar study found that 20 – 35% of patients undergoing cardiac surgery suffered postoperative neuropsychological dysfunction for up to several months. Rodig, R., et al. Evaluation of Self-Reported Failures in Cognitive Function after Cardiac and Noncardiac Surgery. Anaesthesia. September, 1999; 54(9): 826 – 830. Similar results were seen in several other studies yield a 22.5% affected rate (2 months post surgery in six studies) in the review article published by Van Dijk, et al. Neurocogntivie Dysfunction after Coronary Artery Bypass Surger: A Systematic Review. Journal of Thoracic and Cardiovascular Surgery. 2000; 120: 632 – 9. The twenty-three selected studies reviewed all employed neuropsychologic testing for assessment purposes with a 20% testing deficit as the threshold for determining cognitive impairment. The use of neuropsychological testing for determination for this purpose has been found to be essential. Stump, David A. Selection and Clinical Significance of Neuropsychologic Tests. Annals of Thoracic Surgery. 1995; 59: 1340 – 4.

Sleep Apnea

Witnessed apnea includes disheveled sheets due to tossing and turning/restlessness. Nocturia is reported in 28% of patients with 4 – 7 bathroom trips each night. The most common daytime symptoms are fatigue and sleepiness. Sleepiness may be subtle, such as midafternoon drowsiness during meetings, occasional naps. Morning/nocturnal headaches are reported in half of patients. As part of their symptoms, patient may report clumsiness in tasks requiring dexterity, concentration, attention, memory, or judgement and may be of such severity so as to hurt job performance and the ability to hold employment. Family and social life can suffer as well due to various personality changes (anxiety, irritability, aggressiveness, depression) with resulting alienation leading to depression. Bassiri, AG and Guilleminault, AG. Clinical features and evaluation of obstructive sleep apnea-hypopnea syndrome. Kryger, MH, et al, eds. Principles and Practice of Sleep Medicine, 3rd ed., (Saunders 2000):869 – 878.


Claimant suffered a stroke which has produced the common residual effects of speech aphasia, memory impairment, and fatigue. In the study by Peter Hagoort in Impairments of Lexical-Semantic Processing in Aphasia: Evidence from the Processing of Lexical Ambiguities. Brain and Language. 45: 189 – 232 (1993), it was found that stroke victims with aphasia did not suffer from a deficit in their stored memory, but rather could not consciously elaborate as part of their speech resulting in a deficit termed the “impairment in consciousness.”

Memory impairment was found to be independently affected from speech aphasia and not simply a consequence of the language impairment. Beeson, P.M. et al. Memory Impairment and Executive Control in Individuals with Stroke-Induced Aphasia. Brain and Language. 45: 253 – 275 (1993).

Subdural Hematoma

Neuropsychiatric syndromes following traumatic brain injury are not well delineated from classical psychiatric syndromes such as depression, psychosis, or anxiety. Thus, these disorders may present with both features of altered behavior and a brain-based neurological disorder. Increased age is recognized risk factor for development of neuropsychiatric disorder following a traumatic brain injury. 77% of TBI patients will show increased distractibility. Often, slowed information processing speed will be present. These deficits become more apparent when a greater cognitive load (increased demand) is placed on the injured person. Therefore, use of short tasks during testing may not reveal the deficit. Memory is usually the most severely affected due to the high concentration of lesions preferentially found in the frontal and anterior temporal brain structures following closed-head injury. Most recent formed memories tend to most affected with decreased performance on implicit (procedural) memory tasks as opposed to more explicit (factual) memory tasks. 44% of patients with moderate disability will demonstrate memory impairments with larger percentage for more serious cases. Over 50% of patients will experience some specific language deficits. Patients with brain contusions or hematomas tend to show deficits of visual perception. TBI patients also show deficits in executive functions (volitional behavior, planning for the future, purposeful action, and regulating one’s behavior).
Granacher, RP. Traumatic Brain Injury: Methods for Clinical and Forensic Neuropyschiatric Assessment. (CRC Press, 2003): 9 – 30, 47 -55.

Animal experiments have demonstrated that subdural hematoma can cause both immediate and subsequent (progressive) brain dysfunction including cognitive deficits. Eijkenboom, M, et al. Chronic cognitive effects of bilateral subdural haematomas in the rat. Neuroscience. 2004; 124: 523 – 33; Eijkenboom, M, et al. The effects of subdural haematoma on spatial learning in the rat. Neuroscience. 1999; 94(2): 373 – 8.

Posted in Disease |


Your Online Footprint

Watch Your Online Footprint

Facebook and other social media platforms have been a great help to many disabled persons as it provides a means of communicating and socializing with others without requiring travel or physical interaction.  Unfortunately, when it comes to a disability claim, the use of these platforms can become detrimental to you.

Disability insurers are increasingly using private investigation companies to perform background checks on claimants. Part of this process involves investigating claimant social media profiles.  This is a cheap means of acquiring information on claimants which can be utilized to create a “false narrative” alleging much greater daily activities than actually are taking place.

This investigation goes well beyond the typical Facebook profile, but will include LinkedIn, dating sites (Match, OurTime, Chemistry,Tinder, etc.), Instagram, review sites (Yelp, Travel Advisor, etc.), and any other chat groups or posting sites in which you participate.

Examples witnessed by this firm include the following allegations:

  • Ability to take a vacation equates to the ability to work
  • Engaging in a dating site is activity which undermines disability
  • Assisting others in job searching such as resume assistance or career guidance which is equated to starting a new business
  • Volunteering equated to being able to perform work during those time periods
  • Photos showing routine activities used as evidence to undermine claimant claims of physical or mental disability
  • Accusation of insurance fraud for attempting to play tennis by standing and hitting the ball directly to and from the other player without any attempt to win points or keep score

Even if direct allegations cannot be made from the material obtained from the social media checks, the background information may lend itself for more targeted investigation of the claimant.

So, what do you do?

First, secure your Facebook and other profiles so that information cannot be obtained through a simple search and access must be granted.

Next, do not allow strangers to access your social media accounts.  Don’t put it past investigators to use phony profiles to fool you into granting access.  If you are not sure, then do not grant access.

Then, warn close friends and family members and make sure they take down your recent photos documenting any activity.

Even if this is done, if you grant access to an insurer to your credit information, the insurer can find out organizations and associates with which you are involved.

Therefore, if you have a disability insurance claim, you will need to be much more careful in your use of social media.

Is this fair? – No

Is it worth the risk of losing your benefits – NO!!!!!

Posted in General Disability Issues | Tagged |


Social Security Status Update 2017

The 2017 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds set forth the following findings through the end of 2016:

    • The Fund was providing benefits to 11million disabled workers and dependents
    • Total expenditures were $922B while income was $957B
    • “Asset Reserves” in the form of U.S. Treasury Bonds increased from $2,813B to $2,848B. These projected reserves are expected to increase to $3,000B by 2022 and be depleted by 2034
    • Social Security’s total income is projected to exceed its total cost by 2021
    • The Disability Trust Fund has projected income to cover expenditures for the next 10 years
    • The Disability Trust Fund is projected for depletion in 2028 as a result of increasing disability payments with the entire social Security Trust Fund depleted by 2035

These estimates take into account many estimated future variables including life expectancy, disability incidence/termination, employment, gross domestic product, immigration, interest rates, among others. For this reason, the dates and estimates will be revised time and again over the years.

Here is the rub that you of which you must be aware. The government routinely withdraws funds from the Social Security Trust Fund to pay for daily operations. In return, it issues “IOUs” in the form of U.S. Treasury Notes. If these notes were to be redeemed to fund the Social Security Trust Fund, it would require the government to borrow money to supply the needed money. This action would, in turn, necessitate issuance of bonds for purchase which will increase the national debt substantially. The national debt at the time of this writing was $13.6T. The redemption of the Treasury Notes issued to the Social Security Trust Fund would increase this by $2.8T or 22%. Such an enormous debt increase would have repercussions throughout the U.S. economic system in terms of dollar valuation, credit rating, etc.

The most important take away from this discussion is the pressing need for action by the United States Congress. The “kick the can down the road” approach and avoiding the proverbially “third rail” of politics in addressing the impending shortfall in the Social Security Trust Fund is irresponsible.

Unfortunately, there are clear political lines drawn by the parties. Republicans wish to restrict benefits and make eligibility harder whereas Democrats prefer to create funding (through taxes of some type) to insure the Fund’s solvency. Until there is some actual cooperation between the parties, there will be means to address the situation as neither party wants to be solely responsible for changes to the current system due to the political liability inherent in doing so.

Posted in Social Security |


Social Security Disability Case Hearing Delays 2017


Hearings were postponed in 8 – 9% of the cases in 2012 – 16.

The hearing no-show rate for claimants in 2016 was 9%.

No relationship has been found between hearing scheduling and no shows/postponements. It has been attributed to the transient nature of claimants and limited staffing for providing follow-up hearing reminders. In addition, hearing offices with low no show rates have a low number of unrepresented claimants.

76 days elapsed between hearing scheduling and hearing held date in 2016. In 2017, the notification requirement was increased from 20 days to 75 days before the actual hearing.

A Pre-Hearing Conference Expansion pilot program initiated in January, 2016 was discontinued in January, 2017 due to a decision-writing backlog before it could be determined if the program had an effect on reducing no show/postponement rates.

Recommendations from SSA to reduce delays caused by no shows and postponements include:

∙ Using stronger language in the hearing notice so claimants understand that a failure to appeal at the hearing can result in a forfeit of the right to a future hearing

∙ Put the burden on claimants to notify SSA of address changes and create a presumption that failure to do so is evidence of their lack of interest in pursing the claim

∙ Making sure the SSA system incorporates changes reported by field offices

∙ Require claimants to decide if they want a representative before a hearing is scheduled

∙ Give administrative law judges the authority on reporting claimant representatives who are not taking responsibility for representing claimants (appearing at hearings while unprepared)

∙ Ensure sufficient staff hiring

Unfortunately, the Office of the Inspector General failed to address the main cause of no shows and postponements: the huge delays inherent in the Social Security disability claims process. These ridiculous delays, requiring persons to wait up to two years to have a hearing, result in undue hardships to claimants. During the waiting period, it is common for claimants to lose their homes or move their residences on multiple occasions due to a lack of funds to pay for these. In the process, contact with SSA and claims representatives are lost, resulting in a great number of no-shows and causing postponements. Of course, rather than take responsibility for the cause of the problem, SSA proposes solutions which either blame the claimant or the representative.

Posted in Social Security Disability Benefits | Tagged , , , |


An Overview of Social Security Disability Benefits (2017)

There is constant mischaracterization concerning Social Security Disability recipients who are often disparaged as being “too lazy” or “unwilling” to work. The facts reveal a much different reality.

By 2015, there were more than 10 million disabled persons were receiving Social Security Disability benefits. This is decreasing with the aging out of the Baby Boomers into retirement age. This decline began in September, 2014. Any overall rise in applications is a result of the aging population in the United States as 25% of the population is composed of Baby Boomers, the older of whom are in or entering their retirement years.

The annual number of disability awards rose to the highest level so far in 2015 with 839,429, of which 741,478 were disabled workers and the remaining were children and widows.

The final award rate for disabled worker applicants was 35% with 23% awarded at the initial application, 2% at reconsideration, and 10% at hearing. Denied disability claims average 61%.

The average Social Security Disability recipient has worked 22 years before receiving benefits.

8.1 million persons received Social Security Disability, 3.5 million receive Supplemental Security Income, and 1.3 million received both types of benefits. This accounts for only 16% of total benefits paid.

It is estimated that one in four twenty-year age persons will become disabled before reaching age 67.

67% of the private workforce does not have long term disability coverage other than SSD.

31% of workers report having no savings set aside specifically for retirement.

There are currently 2.8 workers for each Social Security beneficiary which will be reduced to 2.2 by 2035.

The average Social Security Disability check is $1170/month.

Many SSD recipients are terminally ill with 1 in 5 males/1 in 6 females dying within 5 years of receiving benefits.

Most SSD recipients who wish to work to supplement their income only have work capacity to earn a few thousand dollars per year.

There is no widespread fraud in the Social Security Disability approval system with studies finding an allowance decision error rate of only 0.6%.

For these reasons, those advancing the argument that too many undeserving persons are receiving Social Security disability are clearly not knowledgeable of the facts.

Posted in Social Security Disability Benefits | Tagged , , |


Why Disability Insurers Pick on Older Workers

Picking on older folks is not just for families and friends anymore. Except, when it is done by disability insurers, the consequences are far more severe.

In general, people are not lizards. We degenerate and do not regenerate. For that reason, most disabling conditions become worse as the aging process proceeds. The insurers act as if this simple fact just does not exist.

Add to this the problems that older workers have obtaining new employment. Regardless of their experience in their respective fields and prior dependability, older workers are commonly viewed as being greater liabilities in terms of increased health care costs, safety concerns, lacking mental flexibility, age-related productivity concerns, and inability to work with younger workers. Further, employers are faced with older workers whose skills have become obsolete and are reluctant to invest in training them. Older workers require extended training as compared to their younger counterparts who tend to learn quicker. This is particularly difficult in an era when many industries are undergoing rapid technological change. Again, disability insurers just invent their own logic which runs contrary to reality.

So, what do disability insurers do? They deny claims for older persons who are making new claims or have been on claim for years. This is done on purpose as it is nothing more than a numbers game. The disability contract only pays to retirement age (ranging from age 65 – 67). So, the insurer will only be liable for a few more years of disability payments at the most. This provides only a small sum by which to decide whether to hire an attorney to fight for the benefits. Many times, the amount is low enough as to preclude contingency fee interest for most attorneys since ERISA-governed benefits are not eligible to sue for compensatory or punitive damages. This gives insurers a distinct advantage and a savings mechanism. Fewer paid claims increases their profit.

Moreover, most of these older claimants are receiving Social Security Disability and are eligible to receive retirement account payments. The other sources of income serve as disincentives for these workers to fight for their private disability payments as they do not wish to be bothered with a legal battle.

We have represented older workers in many of these cases and take insurers to task on these issues. It is patently unfair to treat older worker claims in this fashion. Insurers have a lot to answer for if the case is prepared correctly and all the disability issues are covered. For this reason, you need an experienced disability benefits attorney who is willing to go to court in these cases. It is important to ask about an attorneys experience and court record in advance before making this important decision.

Posted in General Disability Issues | Tagged |


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