Wednesday, August 16, 2006



Social Security Disability SSI and Auto Immune disorder (actually disorders)

As a disability examiner, I saw social security disability and SSI cases for which nearly any physical, psychiatric, or psychological condition you can think of was named as a disabling impairment.

What's very interesting, though, is how many of those impairments (aside from musculoskeletal, respiratory, digestive, endocrine, and cardiovascular) were defined as an autoimmune disorder. In fact, an extraordinary number of impairments are auto-immune disorders.

Here's a list of just the autoimmune disorders I can think of:

  • Ankylosing spondylitis

  • Myasthenia Gravis

  • MS, or multiple sclerosis

  • Type 1 Diabetes

  • Polymyositis

  • Scleroderma

  • Sjogren's syndrome

  • Vasculitis

  • Autoimmune Hepatitis

  • Crohn's Disease

  • Ulcerative Colitis

  • Lupus

  • Grave's Disease

  • Hashimoto's Thyroiditis

  • Rheumatoid Arthritis


Pretty amazing list. Unfortunately, the various state agencies that adjudicate social security disability and SSI claims (known as, depending on the state you live in, the bureau of disability determination, disability determination unit, and, most commonly, as DDS, or disability determination services) do not provide any real training to disability examiners on the nature of auto immune disorders.

Regarding the issue of medical-information training for examiners (please note that I did not say "medical training" but "medical information" training), there are two sides to the argument. One camp would say that you don't need to provide very specific and indepth training to initial claim adjudicators because the focus of the SSD / SSI definition of disability is on "residual function". In other words, you don't have to know much about the disorder itself as long as you know what its limiting effects are. And, to a large extent, this is true, of course. The name or classification of a disorder is secondary to how it affects an individual's ability to work.

However, there's a hole in that argument. Learning more about any particular disease (not just auto-immune disorders, but any condition that may potentially become disabling) could allow for significantly greater competency on the part of a disability examiner to evaluate the medical evidence pertaining to it.

This may be speculative, but I'm willing to bet that if you randomly selected 10 disability examiners, few, if any, would be able to provide a satisfactory definition of ankylosing spondylitis, or multiple sclerosis. And on that subject, few, if any, would be able to define the term auto-immune disorder.

Yes, yes, residual functional capacity and the ability or inability to return to work----that's the focus of evaluating social security disability and SSI claims. But you have to ask the question: how competently can you read and evaluate the MER (medical evidence of record) when you don't even really know what the disorder is. To me, that seems like a fairly bad disconnect.

Without a doubt (in my mind, at least) disability examiners should, for the benefit of claimants, receive ongoing medical information training. This would increase their competency and their ability to provide better writeups and case presentations for the unit medical consultants with whom they work (harder to do a writeup, I would think, when you don't really understand the "implications" of the medical evidence that you read and evaluate on a daily basis). Most likely, this will never happen, of course, due to funding and other issues.

By the way, autoimmune disorders are simply defined as disorders in which the body begins to produce antibodies to attack its own tissue. There are approximately forty medical conditions that carry the autoimmune disorder classification and around five percent of the population may ultimately be affected by an auto immune disorder.




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