Have Questions About the Disability Claims Process for Social Security or Veterans Benefits? Check Out Our FAQs
Dealing with the disability application or appeals process always comes with plenty of questions. Whether your questions are about Social Security or VA Disability, here are some of the questions we hear the most at our Omaha law firm.
- Page 7
Does the VA use the results of a reexamination to reduce my rating?
If you return from military duty with a service-connected disability, disease, or illness, you may be awarded disability benefits from the United States Department of Veterans Affairs (VA). But even though you may receive this financial support initially, the VA is allowed to reassess your claim to reduce or increase your rating at any time.
Generally, a veteran will not be asked to report for a reexamination if he has an unchanging disability such as a missing foot or hand, a permanent type of disability such as hearing loss or blindness, is over the age of 55, or already has the lowest possible rating given for that disability. Additionally, there are ratings considered “protected,” and veterans with those ratings will usually not be requested to take a reexamination.
Most often, the VA will request a reexamination if the agency believes your disability or condition is likely to improve with time. If the VA makes this request, it usually gets scheduled two to five years from when you first received benefits for your disability. Because you want to understand the nature of the exam and how the VA will evaluate your condition, it’s helpful to hire an experienced VA disability lawyer, especially if the VA reduces your rating after receiving your results.
The Results of a Reexamination and How They’re Used
It’s important that if you’re scheduled for a reexamination, you show up for the appointment. If you fail to appear without a good reason, the VA can terminate your disability benefits. This appointment can be a medical exam, or the request could require that you spend time in the hospital for observation. The VA can request either in order to assess your condition and its severity.
Typically, if you’re scheduled for a reexam, it means the VA has evidence or some type of medical report that indicates your award benefits should not continue at the current rate. It’s possible that conditions change over time, and disabilities aren’t always permanent. Even if your condition improves only temporarily, the VA can reduce your rating during the time you’re feeling better. If your disability worsens after the VA reduces your rating, you can request that it and your benefits be reinstated at their original level. It’s the job of the VA to ensure that all veterans are compensated for their injuries accurately and with the proper rating.
When You Do Not Have a Protected Rating
If your rating does not fall under the “protected” category, the VA can reduce your rating after a reexamination if:
- Your disability has improved
- The improvement increases your ability to live and function normally in your life and at your job
- The report results for your reexamination are thorough
- The complete medical history of your condition, disability, or illness has been evaluated
Additionally, the VA can reduce your benefits temporarily if you are arrested and go to jail.
There are generally three possible outcomes of a reexamination. The VA can find that your condition has deteriorated. If this happens, your rating may be increased. The VA can also determine that there’s no change in your condition. In this situation, nothing changes and your ratings won’t be reduced. But the VA may also find that your condition has improved. If the VA receives medical reports or evidence from your reexamination that proves your disability or condition has improved, gone into remission, or disappeared entirely, your rating may be reduced.
We Can Help You With Your VA Reexamination
Before the VA can make any changes to your rating or benefits, the agency must send a notice letter to you requesting that you appear for a reexamination. Cuddigan Law understands the process for responding to this letter and how to submit the proper medical evidence to keep your current rating status. Contact us at (402) 933-5405 to schedule an evaluation to discuss your specific situation.
What happens if the VA decreases my disability rating?
If you’re a veteran and have obtained benefits for a service-connected disability from the United States Department of Veterans Affairs (VA), you may think the process is over. However, a number of potential changes can take place in the years following your initial award that are important to understand. As an approved applicant, you have the right to request a rating increase if you have evidence proving that your illness, disease, or condition has worsened. At the same time, except under special circumstances, the VA can re-evaluate your claim to increase, decrease, or completely terminate your benefits at any time. If the VA has medical evidence that shows your condition has improved, the agency can decrease your rating or stop compensating you for your disability entirely.
Because the process for appealing a VA rating reduction can be tricky, it’s helpful to hire an attorney who has experience working with VA applications, appealing claims, and dealing with proposed rating reductions. You may need an attorney’s skill and expertise to understand the best way to navigate the many VA processes.
When the VA Proposes a Reduction in Your Rating
The VA has the authority to require that you report for follow-up medical exams, especially if the agency is looking into your claim. Like the initial Compensation and Pension (C&P) exam, it’s important that you show up for this exam on the day it’s scheduled. If you fail to report and you don’t have a satisfactory reason for missing the appointment, the VA can reduce compensation or sever it completely.
If medical evidence is obtained by the VA that shows your condition has improved, the agency has the right to reduce your disability rating. However, before the rating is changed, here are some specific steps in the process:
- The VA must follow a formal process that proposes the reduction before the agency actually reduces your rating.
- The VA must send notice to the claimant of the proposed reduction.
- The VA must ensure that there is accurate medical evidence from a legitimate medical exam to support a reduction in the rating.
- The VA must determine that there’s been a real change in the claimant’s disease or illness, not just a limited or short-lived improvement.
- The VA must have enough evidence to support a decision to reduce an entire history of the claimant’s condition.
- The claimant has the right to challenge the reduction and send evidence to refute it.
- The claimant must respond within 30 days to prevent a change in his rating.
Additionally, it’s possible for the VA to terminate your claim. While this action doesn’t happen often, the agency may determine that the initial rating was awarded based on an error, fraud, or some type of illegal or unlawful action. If this happens, the claimant has the same right to challenge the proposed termination of compensation.
Challenging a Proposed Ratings Reduction
If you receive notice from the VA of a proposed rating reduction, you’ll likely want to appeal this proposal. It’s important to understand what can happen during this process. Here is a brief look at some critical points you may want to consider:
- You may have to repay money to the VA if your appeal is not successful.
- If the VA finds that your disability rate was too high, an “overpayment” will be generated that you’ll have to pay back.
- The amount of the overpayment could be significant.
- If you’re unable to repay the overpayment, the VA will likely withhold some amount from any future benefits checks until there is resolution of the overpayment.
Some disability ratings are considered “protected” from a VA proposed reduction; however, no claim is 100 percent secure. In general, veterans have protected benefits if they:
- Have received benefits at the same rating for over five years
- Have reached the age of 55 or older
- Have received their disability compensation for over 20 years
- Have a disability that will never improve such as the loss of an arm or leg
- Have a 100 percent disabled rating or are considered totally and permanently disabled
It is possible for the VA to lower a protected rate, but it’s a more difficult process. It usually doesn’t happen unless the VA can prove there was fraud connected with your initial claim.
Our VA Disability Attorneys Can Help
If you’re a veteran whose disability rating might be decreased, contact the VA disability lawyers at Cuddigan Law at (402) 933-5405. We can help you with the appeals process to ensure that you receive the fairest possible rating. Call us to schedule a case evaluation to discuss your specific situation.
Will I receive higher VA benefits if I request an increase in my disability rating?
If you’ve been approved for service-connected disability benefits from the United States Department of Veterans Affairs (VA), the agency will assign a disability rating that specifies the seriousness of your condition. You can be given a rating of 0 to 100 percent, and this percentage is associated with a certain monetary amount you’ll receive for the disability. Even if you’re assigned a 0 percent rating, the VA still acknowledges that the service-connected condition exists, but it doesn't affect your ability to hold a job or function on a daily basis.
Additionally, a 0 percent rating can increase your healthcare eligibility, and if your condition worsens in the future, you can file to increase your VA disability rating instead of starting the application process over. To receive VA benefits, you don’t have to be completely disabled; however, your condition must have a 10 percent rating to receive financial compensation.
Making the Case for a Rating Increase
There may come a point after you’ve received VA benefits for a period of time that your disability begins to worsen. You may experience greater pain, suffer broader or more challenging symptoms, or find that your day-to-day functioning has decreased. You may even find that it’s getting harder to work and sustain gainful employment. If this happens, you may feel that the percentage rating you were assigned when your claim was first approved is no longer high enough to represent the deterioration and regression in your health due to your disability. Ultimately, you may want to ask the VA for a rating increase.
The process for making this request isn’t difficult. However, the outcome of this request may not be exactly what you expect or intend. It’s possible that making a request for this change can actually lower your disability rating. Thus, it’s helpful to hire a lawyer who can explain why a request for an increase can mean a higher rating without an increase in financial compensation and why it can ultimately decrease your percentage rating.
Why Your Rating and Benefits Could Decrease
Before you ask for an increase in your VA rating, be sure you’re making the request strictly because you believe your disability has become worse. You shouldn’t request an increase if:
- You need more money to keep up with the cost of living,
- You have additional financial responsibilities,
- You are suffering sudden financial hardships
The VA won’t award an increase for these reasons. But if you believe your condition has truly deteriorated, you can complete and file a form 21-526b, Veteran's Supplemental Claim for Compensation or a form 21-526EZ to the VA Regional Office (VARO) stating why you believe the increase is proper and appropriate along with medical evidence that supports the worsening state of your disability.
It seems logical that if you’re awarded a higher disability rating, you will receive a larger monthly check from the VA. However, the process doesn’t always work that way. It’s possible that a small increase added to your rating will have little impact on the amount of your compensation.
For example, if your rating is already at 60 percent, an increase of 10 percent may not impact the bottom line. The VA uses complicated formulas and combined ratings tables to decide the percentage. Thus, an attorney experienced in VA disability benefits can help determine if you’re likely to receive an increased rating and an increase in financial compensation.
When the VA receives your claim, the agency will review your entire file. This means your initial rating will be re-evaluated and all of your medical records scrutinized. This can have a positive or negative outcome. The VA may actually decrease your rating based on the new medical evidence you provide about your condition. If they don’t see deterioration and, instead, see improvement in your current disability, the VA may reduce your benefits.
Here’s How Your Request to Change VA Disability Rating Works
At any time, the VA can re-examine your claim, and the agency can reduce or terminate your benefits under some specific circumstances. Most often, however, the VA won’t do this before and until you appear for a reexamination. When you request an increase in your VA disability rating, you are in effect opening up your claim for re-evaluation. In general, here are some basic guidelines the VA uses when determining changes in your benefits:
- If you’ve had your service-connected disability rating for over five years, the VA has to prove that your illness or disease has improved in a consistent way before reducing or terminating your rating.
- If you’ve had your disability for 10 years or more, the VA will not likely terminate your benefits unless the agency can prove that you’ve been fraudulent in your claim. It can, however, reduce your benefits.
- If you’ve had your disability for 20 years, the VA won’t reduce your rating below the lowest rating you’ve received in those 20 years.
To reduce your disability rating, the VA must have specific evidence that your condition has improved. The responsibility of proof is on the VA. However, it’s important to be diligent in protecting your rating. It’s important never to miss a reexamination appointment because the VA can reduce or terminate your rating without warning because of this.
Our VA Disability Lawyers Are Here to Help
When your service-connected disability has worsened and you want to request a rating increase, contact the VA disability lawyers at Cuddigan Law at (402) 933-5405. We can help you with your request to ensure you get the fairest possible rating. Call us to schedule a case evaluation to discuss your specific situation.
What illnesses and medical conditions are linked to the Gulf War?
After returning home from the Persian Gulf War, you may have experienced unexplained illnesses and symptoms that have no apparent link to specific medical conditions. These symptoms are often referred to as Gulf War Syndrome (GWS), “Desert Storm Disease,” and/or “Gulf War Illness.”
Initially, veterans who suffered these unexplained symptoms were believed to have problems psychologically, and their pain, fatigue, and cognitive issues weren't considered serious or real. However, researchers analyzed more than 100 studies focused on these illnesses, and the results revealed that exposure to certain chemicals could be linked to the symptoms veterans experienced. These chemicals included:
- The nerve gas Sarin
- An anti-nerve gas drug, pyridostigmine bromide
Gulf War veterans may qualify for benefits from the United States Department of Veterans Affairs (VA), but there are challenges involved in filing a claim for GWS. Because the VA denied approximately 80 percent of claims by Gulf War veterans in 2015, veterans often have many questions about how to get medical evidence for these illnesses and the best way to file a claim. An attorney experienced in the VA application process can answer your questions and help with your claim.
Questions About Unexplained Gulf War Illnesses and Conditions
Of the 700,000 soldiers who served in the Persian Gulf War from 1990–1991, approximately 30 percent developed GWS. The symptoms of GWS can be varied, debilitating, and different for every veteran; thus, they’re hard to classify with a single diagnosis. This is one reason why the VA prefers not to use the term "Gulf War Syndrome" and instead refers to the condition as a "chronic multisymptom illness" or an "undiagnosed illness." This makes it difficult to determine if a veteran's condition is related to service and eligible for VA benefits.
How Do I Know If I Have GWS?
There are many different symptoms of GWS, and no veteran experiences the condition the same way. However, here is a brief look at some of the typical symptoms of GWS:
- Neurological issues
- Memory problems
- Arthritis and joint problems
- Gastrointestinal and respiratory disorders
- Rashes and skin conditions
- Headaches and fatigue
Do Veterans Who Suffer From GWS Also Have Chronic Fatigue Syndrome?
Chronic fatigue syndrome (CFS) is definitely a condition associated with GWS. Veterans with CFS often experience long-term, severe exhaustion that isn’t related to another illness and doesn’t resolve after resting. To be diagnosed with CFS, the Centers for Disease Control and Prevention states that the exhaustion must persist beyond six months and be present in combination with at least four other conditions, including headaches, memory loss, muscle pain, and tender neck or armpit lymph nodes.
If you’re a veteran seeking VA disability for CFS, you need medical evidence that shows that the new onset of fatigue is debilitating and has decreased your normal daily routine by 50 percent for at least six months. It’s also important that your medical reports show evidence that there is no other possible illness or condition that could produce similar symptoms.
Why Have I Returned Home From the Gulf War With Gastrointestinal (GI) Problems?
GI disorders present in a wide range of symptoms, including abdominal pain, dyspepsia, constipation, bloating, vomiting, and irritable bowel syndrome (IBS). Many civilians have IBS; however, many combat soldiers were diagnosed with IBS after returning home from war. Of those veterans who served in the military and did not have IBS, approximately 20 percent returned from active duty in Afghanistan and Iraq and developed this disease. The VA presumed a service connection and defined new guidelines for benefit eligibility.
Veterans appear to have a greater risk for IBS because the condition is more prevalent in people with a high level of anxiety. This is especially true if that anxiety is associated with specific life events that are particularly stressful. Combat soldiers who experience trauma, life and death situations, and worry about being away from family and friends may suffer from stress that could increase their risk of developing IBS.
Am I Eligible for VA Disability?
Possibly, if you meet the following qualifications:
- Proof that you served in active duty in Southwest Asia in the Red Sea; the Gulf of Aden; the Persian Gulf, or the Gulf of Oman; the neutral zone between Saudi Arabia and Iraq; or the United Arab Emirates, Kuwait, Iraq, Bahrain, Saudi Arabia, Oman, Qatar, or Afghanistan. This active duty also includes flying in the airspace above these areas. If you served in Turkey, you're not considered a Gulf War veteran.
- Documentation clarifying you're a veteran of the Persian Gulf War.
- Medical records detailing your chronic disability and how it may qualify for benefits.
- Proof you sustained the disability while on active duty.
- Proof your disability is service-connected if it developed after you returned home.
Keep in mind that the VA must assign a 10 percent or higher rating to your disability before any consideration of benefits.
We Can Help
Obtaining VA benefits for GWS can be a challenge. If you’re a veteran who suffers from service-related symptoms and wonder if you're eligible for benefits; or if your GWS disability claim was denied, call Cuddigan Law at 402- 933-5405. We can help determine if you qualify for VA disability.
How does the VA rate Gulf War Syndrome?
Soon after the Persian Gulf War, the American Legion Service Officers received complaints from veterans about medical issues they sustained while serving in Southwest Asia. They suffered from a broad range of unexplained illnesses and symptoms, including skin rashes, memory loss, joint and muscle pain, fatigue, and headaches.
However, both the U.S. Department of Veterans Affairs (VA) and the Department of Defense (DoD) dismissed these symptoms as being psychological in nature or stress-related. Some of these veterans were prescribed mood altering drugs such as Prozac, and others were accused of feigning their illness or exaggerating their condition.
A major issue for Gulf War veterans was that they suffered from a cluster of symptoms which could not be easily diagnosed or attributed to a known disease or condition. Ultimately, these symptoms were referred to as Gulf War Syndrome (GWS) or “Desert Storm Disease,” and/or “Gulf War Illness.”
In 2009, the VA took steps to provide benefits for veterans of the Gulf War suffering from what it preferred to call "chronic multisymptom illnesses" or an "undiagnosed illnesses." This also included Amyotrophic Lateral Sclerosis, or ALS, Parkinson’s disease and Alzheimer’s disease.
While it’s possible for Gulf War veterans to qualify for VA benefits, getting a claim approved isn’t always easy. Because many GWS claims are denied, it may be helpful to hire an attorney experienced with the VA application process, especially one who understands GWS.
Three Symptom Categories the VA Rates for Gulf War Syndrome
GWS comprises a cluster of symptoms that are categorized into three main areas: undiagnosed illnesses, multisymptom illnesses, and presumptive disorders. Here's a brief look at these categories.
It’s possible for a veteran with one or more of the following unexplained illnesses to qualify for VA benefits through a presumptive service connection:
- Cardiovascular disease
- Joint and muscle pain
- Psychological and neurological issues
- Rashes and skin conditions
- Respiratory problems
- Trouble sleeping
The following conditions are included in the multisymptom illnesses category:
- Functional gastrointestinal disorders, including: IBS, bloating, constipation, abdominal pain, dysphagia, vomiting, and dyspepsia.
Those veterans who served in Afghanistan may have an infectious disease that the VA considers service-connected:
- Campylobacter jejuni
- Coxiella burnetii (Q fever)
- Mycobacterium tuberculosis
- Nontyphoid salmonella
- Visceral leishmaniasis
- West Nile Virus
Except for mycobaterum tuberculosis and visceral leishmaniasis, each of these diseases must have a 10 percent rating or more within one year of service.
Disability for Gulf War Syndrome
A successful VA disability claim must be able to prove that you were a veteran honorably discharged; that you have a current disability; that the disability occurred while in service; and there is a connection between the service event and your current disability.
However, to qualify as a Gulf War veteran, you must also prove:
- You served in active duty in Southwest Asia in the following countries or areas and/or airspace above them:
- The neutral zone between Saudi Arabia and Iraq
- The Red Sea, the Gulf of Aden, the Persian Gulf, or the Gulf of Oman
- The United Arab Emirates, Kuwait, Iraq, Bahrain, Saudi Arabia, Oman, Qatar, or Afghanistan.
- You served in Afghanistan on or after September 19, 2001.
- Your unexplained illnesses or condition occurred during active service prior to December 31, 2016.
- Your disability has a rating of 10 percent or higher.
- Your disability has no other cause other than your service in the Southwest Asia theater or Afghanistan.
- Your disability has been on-going for six months or longer.
We Can Help
The attorneys at Cuddigan Law understand how difficult it is for veterans of the Gulf War to get their GWS claims approved. They know that approximately 80 percent of GWS claims made in 2015 were denied. If you're a veteran suffering symptoms you believe are associated with your military service in the Gulf War; or if you've applied and were denied benefits, call Cuddigan Law at 402-933-5405. We can help determine if you qualify for VA disability.
How will a hepatitis C diagnosis impact my life, and can I receive disability benefits?
Known as the “silent epidemic,” hepatitis C is a disease caused by a virus—the hepatitis C virus (HCV) that infects the liver. This disease causes the liver to scar, swell, and sometimes fail. The infection is spread most often through contact with blood from an infected person. It’s possible for a person to have the infection for years and not know it.
Hepatitis C can affect people as an acute or a chronic infection. Acute hepatitis C is defined as a new infection that lasts for a short time and may or may not respond to treatment. If the infection does run its course and responds to anti-viral medication, it may clear up on its own. Chronic hepatitis C, however, does not resolve, and a patient may suffer permanent liver damage. It’s a long-term condition that can last a lifetime, and the virus will remain in the body and can cause liver cancer or cirrhosis.
Approximately 30,500 cases of acute hepatitis C were reported in the U.S. in 2014. And over three million people live with chronic hepatitis C. It is very likely that if you have acute hepatitis it will develop into the chronic infection.
Questions About Hepatitis C
Hepatitis C is found in people worldwide, but the regions most affected are Central and East Asia and Africa. Certain populations within countries can see a greater concentration of the infection, including areas where there is a higher rate of drug use. Because approximately 70 percent of people who have hepatitis C don’t know it, over 15,000 Americans die from this disease every year. Here are some of the most common questions about hepatitis C and some general answers to those questions:
Is it true there’s no cure for hepatitis C? Actually, this is not entirely true. Patients with this disease can be treated and “cured”—meaning that after your treatment has ended, the hepatitis C virus can no longer be detected in your blood. It is still possible, however, to have a relapse or suffer a reinfection, and you can still have liver disease.
How do people become infected with hepatitis C? This disease is a blood-borne virus. It’s passed from one individual to another when an uninfected person comes in contact with the blood of someone infected with the virus. There are a variety of ways a person can acquire hepatitis C, including:
- Sharing needles and snorting or injecting drugs
- Sharing clippers, razors, toothbrushes, and other items that may have touched infected blood
- Using piercing or tattoo equipment used on another person
Why do so many veterans have hepatitis C? Approximately 200,000 veterans suffer from hepatitis C. An estimated 60 percent of these veterans served during the Vietnam era. Most veterans contracted it in Vietnam, where it was thought to be spread by battlefield blood transfusions and vaccinations. The United States Department of Veterans Affairs (VA) believes there may be a relationship between the infection and immunizations that were administered using jet injectors—air-gun injections.
Can a person transmit HCV through a kiss? According to the CDC, you can’t acquire HCV if you kiss, hug, or hold hands with someone who has the virus. Additionally, HCV cannot be transmitted through a sneeze or a cough, through a mother’s breast milk, or by eating with utensils that were used by someone with the infection.
HCV has been called a “silent epidemic.” How do I know if I have the virus? Nearly 80 percent of people with acute hepatitis C present no signs or symptoms. If there are signs, they often show up two weeks to six months after a person is exposed to the virus. Typically, symptoms often mimic the flu and can include:
- Extreme fatigue
- Muscle soreness
- Pain in the joints
- Poor appetite or nausea
- Urine that is dark in color
- Jaundice—a yellow discoloration of the skin and whites of the eyes
The only way to know if you have hepatitis C is to get a blood test called the Hepatitis C Antibody Test.
Who is most at risk for contracting hepatitis C? Having the Hepatitis C Antibody Test is recommended for many people, including:
- People who were born between 1945 – 1965.
- Veterans who served in the Vietnam War and received vaccines through needle-less “jet guns”
- People who received organ transplants or donated blood prior to 1992
- People who have ever used needles to inject drugs, even if it only happened once or many years in the past
- People who have HIV or AIDS or chronic liver disease
- People who were exposed to the blood of a person with hepatitis C
- People who are on hemodialysis
- People who were born to a mother who has the virus
If you believe you’ve been exposed to hepatitis C or you’ve been diagnosed with this disease, let Cuddigan Law help you file for VA or Social Security Disability. If you’ve already filed and were denied, we can help with your appeal. Contact us at (402) 933-5405 for a free evaluation of your case.
How does the new Social Security ruling affect my fibromyalgia case?
Many people who suffer from fibromyalgia (FM) are denied Social Security benefits when they apply to the Social Security Administration (SSA) for disability. Administrative law judges (ALJs) and claims examiners are often reluctant to approve applications for FM for a number of reasons. The primary reason is that there is no listing for this condition in the Social Security “Blue Book” Listing of Impairments. Another reason is that examiners place less significance on an FM claim unless the applicant has some other type of condition along with it. If the secondary condition had medical evidence—for example, blood tests or x-rays—the claim is given more weight. Because the symptoms of FM can present like symptoms of other illnesses, the causes aren’t clear, and diagnosing the symptoms can be subjective, disability examiners are not always sure how to classify cases of FM. However, as researchers and medical personnel have learned more about FM, Social Security now has new standards for how to assess this condition.
To address these issues, the SSA published a new ruling that helps examiners and ALJs evaluate FM, even if the symptoms can’t be confirmed or validated by definitive testing, as with conditions such as degenerative disc disease or rheumatoid arthritis. The ruling should help those who are initially denied benefits to win during the appeals process.
Medically Determinable Impairments and the New 2012 SSA Fibromyalgia Ruling
To be eligible for Social Security benefits, you must have medical evidence of that disease that’s established through blood tests, scans, x-rays, and other definitive tests. Your impairment cannot be determined through personal accounts and details of your symptoms. Thus, you’re required to have a “medically determinable impairment” (MDI), and there must be medical signs of the impairment that the SSA can see cause your symptoms. But because these symptoms are often difficult to prove—widespread pain throughout the body, tenderness in the joints, muscles, and soft tissues, fatigue, fibro fog, and dizziness—it’s not easy to get a Social Security claim for FM approved.
In 2012 however, Social Security issued a new ruling defining when FM is considered an MDI. The ruling stated that examiners and ALJs were to use criteria established by the American College of Rheumatology to decide if an applicant’s FM was an MDI. This determination is made in the following ways:
The patient needs evidence that he suffers from widespread, chronic pain that has lasted for at least three months. The pain must be in his chest, neck, or back. Through the use of lab tests or x-rays, a doctor must have eliminated other diseases such as multiple sclerosis and lupus as the cause of the symptoms.
The patient must show signs of one of the following: Eleven of eighteen “tender points,” in specified tender point areas on the body. These tender points must be felt above and below the waist and on both sides of the body. Six or more FM symptoms must occur repeatedly, particularly memory problems, depression, anxiety, fatigue, or irritable bowel syndrome (IBS). A patient can experience other symptoms, including muscle weakness, seizures, and dizziness.
The examiner will review your medical records to ensure that they include enough evidence based on these criteria. After reading your doctor’s notes, the examiner may ask for more information: data on how long you’ve experienced your impairment; the doctor’s opinion of how well you can function on a daily basis or at a job; the type of treatments you were given and if you suffered any side effects; and the period of time he expects that your activity will be reduced. It’s important to note that these criteria only establish that your FM is an MDI; it does not establish whether you’re disabled. Even if you meet the listed criteria, you must prove to the SSA that you can’t work at your current job or any other U.S. job.
However, even with the new ruling, it is still possible that FM sufferers will continue to see their benefits denied initially. Even if they’ve been under a doctor’s care for an extended period of time for this condition, applicants may still need to appeal their claims.
We Can Help
If you suffer from symptoms of FM that make it impossible to sustain gainful employment, and you’ve been denied benefits in the past, the SSA’s new ruling you help you appeal the decision. If you need help applying for Social Security Disability benefits, or you’ve applied and were denied, call Cuddigan Law at 402-933-5405. We’ll schedule an appointment to discuss your eligibility for compensation.
How will the VA rating changes for sleep apnea affect my disability?
Sleep apnea is a breathing disorder that interrupts a person’s breathing. This interruption can last from 10 to 30 seconds and may occur up to 400 times a night for those who suffer from a severe case of this condition. Because sleep apnea is both a chronic and progressive condition, it usually worsens over time.
Those who suffer from this chronic condition are at risk of a variety of problems, including four times greater risk of stroke, three times greater risk of heart disease, and an increased chance of being involved in a traffic accident. According to the National Highway Traffic Safety Administration (NHTSA), drowsy driving related to symptoms of sleep apnea is responsible for 100,000 car accidents and over 1,500 deaths a year.
Veterans are particularly susceptible to sleep apnea. Over 420,000 veterans who served in the military following 9/11 and receive disability from the United States Department of Veterans Affairs (VA) have sleep apnea that is service-connected. And although there are many causes of this condition, including age, obesity, and a deviated septum, many doctors believe this condition is also caused by long-term exposure to chemicals and dust. Military personnel often work and fight in environments that contribute to sleep apnea.
Because sleep apnea has been associated with fatigue, heart problems, hypertension, and memory problems, it’s possible for this condition to interfere with your ability to work or sustain gainful employment. If so, you may be eligible for VA Disability benefits. However, the VA rating for sleep apnea is changing, and you may have questions about how those changes affect your current disability or your eligibility if you want to apply.
Questions About the New VA Rating Changes for Sleep Apnea
Because so many veterans are on disability for sleep apnea, the changes to the rating system could have a broad and significant impact. If you’re receiving VA compensation for sleep apnea, here are answers to some questions you may have:
- What are the new changes being made to the VA sleep apnea rating system? There are two changes being made to the rating. Change 1: A veteran must show that the CPAP he’s using is a medical necessity. Thus, a letter from your doctor will be needed to explain that the prescribed breathing device is needed for medical treatment of your sleep apnea. Change 2: Veterans can use breathing devices other than a CPAP and still be eligible for a rating of 50 percent. This is helpful for veterans because doctors can prescribe different devices to treat sleep apnea, including APAP and BiPAP machines and dental aids. Consequently, if your doctor prescribes a CPAP or any other breathing device, and he can provide evidence that in order to treat your sleep apnea condition, your device is medically necessary, it’s likely you’ll be approved for a 50 percent rating.
- Why did the VA make these changes? A primary factor is the cost of sleep apnea disability for veterans. Disability compensation claims for veterans suffering from sleep apnea increased by 150 percent from 2009 to 2014, and according to reports, annual compensation for this condition continues to rise. Additionally, approximately 9 of 10 veterans who receive disability for sleep apnea are given a 50 percent disabled rating. This can mean a monthly payment of over $800.00. Due to the increased cost of compensating for this condition, the rules were reviewed.
- Will the changes affect my current disability benefits or a pending claim? The M21 – 1MR VA Handbook does not specifically state how the changes will impact current and pending claims. It’s recommended that you look at your C-File to see if there is a doctor’s statement providing solid evidence that your breathing device is a medical requirement in treating your sleep apnea. If there is no such statement, it’s a good idea to get one from your doctor and add it to your file. Additionally, ask that your doctor explain why you need the device as if he is providing evidence to an insurance company. Ask that he be detailed and give clear reasons for prescribing the device. If you have a VA doctor, you may want to invest in getting this letter from a private physician. It’s possible that a VA doctor won’t agree to provide this letter for you.
- What if I don’t use my breathing device as often as I should or the way I’m supposed to? The VA rule change states: “If the competent medical evidence of record shows that use of a qualifying breathing assistance device is medically required, the fact that the claimant is not actually using it as prescribed is not relevant.” So for now, if your use of the breathing device is not compliant with the required use, the VA will not reduce or stop your benefits. However, all other medical systems require that, in order to be covered by insurance, a patient must use the breathing device properly and consistently. Thus, it’s possible that the VA will also require that a patient be compliant with his device.
If you are a veteran who suffers from sleep apnea due to your military service, and your symptoms make it difficult to work, or you were denied benefits for this condition, contact us at 402-933-5405. We’ll discuss your situation and determine how we can help get you the VA benefits you deserve.
I believe I’m suffering from fibromyalgia. What should I know about this condition, and can I get disability benefits?
Formerly known as fibrositis, fibromyalgia (FM) is a chronic condition that affects about five percent of the U.S. population. However, because the symptoms of FM vary by individual, it’s a difficult condition to diagnose. The statistics for people suffering from FM are often estimates rather than exact numbers.
While FM is a condition that affects many people, studies show that veterans of the Gulf War are more frequently diagnosed with FM than civilians or non-Gulf War veterans. Additionally, FM is more common in women and characterized by widespread pain in the body’s ligaments and muscles. Very often, people who suffer from FM have had the condition for years before their doctor makes the diagnosis.
According to the American College of Rheumatology, FM is the second most common medical condition that affects the musculoskeletal system (after osteoarthritis). Those with FM not only experience muscle tenderness and pain, they often have “trigger points” that are painful to the touch or with pressure. These trigger points are usually found on the shoulders, neck, arms, hips, and back. Interestingly, those suffering from FM find these trigger spots especially sensitive, but other similar spots on their body are not sensitive. Additionally, people who suffer from other chronic pain conditions such as arthritis don’t find that pressure on those trigger spots is painful.
If you suffer from FM, you may be eligible for Social Security Disability benefits or benefits from the United States Department of Veterans Affairs (VA). To navigate the appeal process to receive benefits for FM, you may want a legal expert to help with your claim.
The Causes of Fibromyalgia
There is no known cause of FM; however, most researchers believe FM is a result of a combination of many types of stressors—not just caused by a single event. Additionally, there are some known factors believed to contribute to or be associated with the development of this condition. Here is a brief look at some factors connected with FM:
- Genetics. While there is no direct genetic link between people who suffer FM—the condition is not passed from parent to child—studies show that people who develop FM are likely to have a family member with this condition. FM has been shown to run in families, especially in mothers and daughters. Thus, it’s possible that heredity is a factor in developing FM.
- A stressful event. Some studies suggest that those people who have experienced physical or emotional trauma or abuse are more likely to suffer from FM.
- Chronic pain from another condition. FM has been linked with other illnesses. The chronic pain of arthritis, systemic lupus erythematosus, and other autoimmune diseases can trigger or factor into the development of FM.
- Infection. Certain infections can bring about FM. Hepatitis C, the Epstein Barr virus, and other infections are linked to FM.
- Repetitive injuries. If you overuse your hands to perform a task repeatedly, such as working with the same tool throughout the day, typing, or writing, you may suffer from Repetitive Strain Injury (RSI). This can be a debilitating condition that has been linked to fibromyalgia.
- Age. While it’s possible for children to develop fibromyalgia, the ages of most who develop this condition range from 20 – 60 years old. Most people develop symptoms during middle age.
- Diet. It’s thought that certain foods may exacerbate the symptoms of FM, including caffeine, dairy, eggplant, potatoes, tomatoes, peppers, fried foods, salty foods, and alcohol.
Researchers do seem to agree that in those who suffer from FM, the brain and spinal cord seem to process pain sensations abnormally. The threshold for pain may be lower, and pain is felt more intensely because the abnormalities in the central nervous system amplify the pain.
We Can Help
FM isn’t a new disease, but only recently have researchers and doctors understood and accepted it. In the past, FM wasn’t always considered a real condition, and some believed it was “all in the head.” However, a 1981 scientific study confirmed FM symptoms and the associated trigger points. Since that time, more testing has been performed on the pain reactions in people with FM.
If you’re a civilian or a veteran and suffer from fibromyalgia and are unable to work, you may be eligible for Social Security or VA disability benefits. Or if you’ve applied and were denied benefits, call Cuddigan Law at (402) 933-5405. We’ll schedule an appointment to discuss your eligibility for compensation.
If I have a family history of RA, what signs and symptoms should I watch for?
Rheumatoid arthritis (RA) is the most common type of inflammatory arthritis. It’s a chronic disease that causes stiffness, pain, redness, and swelling in the joints. In time, any of the joints that are impacted may become damaged, misaligned, and possibly misshapen. The joint’s tissue lining can thicken and wear away at the ligaments, bone, and cartilage that surround it. Most often, if you have RA in one hand or one knee, the joint in the other hand or knee will also have it.
People of every ethnic background, race, age, and gender can suffer from RA; however, approximately 75 percent are women. While the cause of RA isn’t known, researchers have a clearer picture of how genetics and the body’s immune system influence the inflammatory processes that factor into the development of RA.
If you are one of the 1.3 million Americans who suffer from RA, you may be eligible for Social Security Disability benefits from the Social Security Administration (SSA). The SSA’s “Blue Book” Impairment Listing provides the criteria to qualify for benefits. Even if you’re eligible for disability, you may want a legal expert to help with your claim.
What Are the Symptoms of RA?
Morning stiffness is the trademark symptom of RA. Unlike stiffness from osteoarthritis (OA) that usually ends in about 30 minutes, the stiffness of RA can last for an hour or more. Patients usually experience worsened symptoms of stiffness after they’ve been sitting for a long time and after sleeping. Here is a brief look at other major symptoms of RA:
- Pain and swelling. Inflamed joints usually swell and feel warm to the touch. To be diagnosed with RA, joint pain and swelling must occur for six weeks or more. While symmetrical joints are usually affected—fingers on both hands, both knees, both shoulders—sometimes the pain may be more severe on one side of the body. Joints that are most commonly affected are the wrists and knuckles; however, the balls of the feet and knees are often impacted, too. Other joints may be attacked, including those in the shoulders, elbows, jaw, and cervical spine. It’s rare for RA to develop in the fingertips—it’s more common in OA. However, RA sufferers may feel pain at the base of the fingers.
- Nodules or lumps under the skin. When small blood vessels are inflamed, they can cause nodules or lumps under the skin. This occurs in approximately 20 percent of people who suffer from RA. These lumps are usually no larger than a pea and, although they can be located anywhere, they are most often found near the elbow. These nodules may occur throughout the duration of a patient’s condition. It’s possible for the nodules to become infected if they are in areas of the body that handle stress, such as the ankles; however, these infections are rare. Additionally, the occurrence of nodules may mean that the patient has rheumatoid vasculitis—which impacts the blood vessels in other organs such as the kidneys and lungs.
- A buildup of fluid. People who suffer from RA may accumulate fluid in certain areas of the body, especially in the ankles. Likewise, the joint sac behind the knee may collect fluid that can form into a Baker’s cyst—a tumor-like growth that can cause pain down the back of the calf.
- Characteristics of the flu. Sometimes the symptoms of RA present like the flu. Patients may feel tired, lose weight, and have a fever. These symptoms often occur in the early stages of RA and have been described as flu-like or similar to a cold.
- A rash. In children, juvenile rheumatoid arthritis (JRA)—also called Still’s disease—will often present with a pink skin rash along with a high fever, chills, and joint pain and swelling.
We Can Help
If you suffer from RA and are unable to work, you may be eligible for Social Security disability benefits. Because the SSA recognizes the severity of RA and how debilitating it can be, you can qualify with the appropriate medical evidence. Let the lawyers at Cuddigan Law help you provide that evidence and submit your claim. Or if you’ve applied and were denied benefits, call us at (402) 933-5405. We’ll schedule an appointment to discuss your eligibility for compensation.