Social Security Claims
INTERSTITIAL CYSTITIS SOCIAL
SECURITY DISABILITY CLAIMS
By: Pitt
Dickey - Attorney
Interstitial Cystitis and
Social Security - This column will examine how the
Social Security Administration (SSA) evaluates disability claims
which involve a bladder condition called Interstitial Cystitis
(IC). Interstitial Cystitis is a very painful disease that effects
the bladder. It seems to primarily attack women and can occur
before the age of eighteen.
This condition can be difficult
to diagnose. Women suffering from it may have had a number of
unsuccessful surgical procedures and unsuccessful medical
treatment to relieve their chronic pain. The SSA in evaluating
health conditions typically uses criteria called
"Listings" to evaluate most common health problems from
a disability standpoint. Interstitial Cystitis is not a common
enough problem to have its own SSA Listing. However the SSA issued
a Ruling on November 5th 2002 which specifically guides the
evaluation of IC disability claims.
Although the Social Security
Administration still does not have an actual listing for IC, it
should be encouraging for people with this painful condition that
the SSA has issued a Ruling which recognizes the seriousness of
this health problem.
This column will try to translate
this new Ruling into understandable English. The ruling describes
IC as a "complex, chronic bladder disorder characterized by
urinary frequency, urinary urgency and pelvic pain." IC may
also be "associated with other disorders such as
fibromyalgia, chronic fatigue syndrome, allergies, irritable bowel
syndrome, inflammatory bowel syndrome, endometriosis and vulvar/vaginal
pain." IC has also been known to be associated with systemic
lupus.
The cause of IC is not known. The
SSA recognizes that the various treatments for IC are not cures
but attempts to deal with the symptoms of IC. Unfortunately some
patients continue to have IC symptoms despite the various types of
treatment. In my unscientific survey of clients in my practice, IC
is apparently difficult to diagnose as most of the clients have
been treated for a variety of ailments before the final diagnosis
of IC is determined. The regulations state that diagnosis of IC is
"one of exclusion."
The treating doctor must exclude
other diseases before making a diagnosis of IC because "there
is currently no definitive test to identify IC." The symptoms
of IC mimic a variety of other health problems such as "acute
urinary tract or vaginal infections, post radiation bladder
inflammation or infection, bladder cancer, kidney stones,
endometriosis, neurological disorders, sexually transacted
diseases and in men, chronic bacterial and nonbacterial
prostratitis."
The SSA ruling recognizes that
the three most common symptoms of IC are " an urgent need to
urinate (urgency), a frequent need to urinate (frequency), and
pain in the bladder and pelvic region." The pain aspect can
vary from mild all the way to severe. The pain will sometimes
lessen as the bladder is emptied and increase as the bladder
fills. The ruling acknowledges that many people can have vaginal
or testicular pain, low back pain, and thigh pain. Pain symptoms
in females may become worse around menstrual periods.
The SSA’s diagnosis of IC is
based upon medical findings that have some or all of the
following: "presence of urinary urgency or frequency (day or
night); pain in the bladder and surrounding pelvic region; supra
pubic tenderness on physical examination, pinpoint bleeding caused
by recurrent irritation on the bladder wall after a cystoscopy,
ulcers on the bladder wall, and absence of other disorders which
could cause the symptoms."
The standard test for IC
diagnosis is a cystoscopy in which a liquid is used to fill the
bladder to determine if there is bleeding or ulcers on the bladder
wall. A biopsy may be performed to rule out bladder cancer. The
SSA will not pay for a cystoscopy for a claimant seeking
disability benefits as the SSA does not pay for invasive medical
procedures.
The SSA will generally rely on
the treating physician’s diagnosis of IC as a "medically
determinable impairment." In order to award disability
benefits the SSA must find that the claimant has a "medically
determinable impairment". The SSA then has to decide if the
IC is "severe" and if the IC meets or equals the
requirements of a listed impairment.
An impairment is considered
"severe" when it alone or in combination with other
impairments "significantly limits an individual’s physical
or mental abilities to do basic work activities." The SSA
also considers the effects of pain or fatigue from IC which could
limit a person’s ability to perform work activities.
The new Ruling states that since
there is no Listing for IC, the SSA will find a claimant
"meets" the requirement of a Listing for another
impairment or "equals" if the person has "multiple
impairments including IC, no one of which meets or equals a
listing, but the combination of impairments is the equivalent in
severity to a listed impairment."
The new Ruling states that the
SSA "will never (solely) deny an individual’s claim because
the individual’s IC does not meet or medically equal a
listing." If a claimant’s IC is so severe that she cannot
perform work activities the SSA can still award disability
benefits.
The SSA Ruling recognizes that IC
can limit the ability of a claimant to function in a number of
ways which include frequency and pain. IC can cause limitations in
physical functions such as "sitting, standing, walking,
lifting, carrying, pushing and pulling." IC can also have
more subtle effects such as "many people with IC have chronic
pelvic pain which can affect the ability to focus and sustain
attention on the task at hand.
Nocturia (night time urinary
frequency) may disrupt sleeping patterns. This can lead to
drowsiness and lack of mental clarity during the day." IC can
limit social functioning as urinary frequency as often as every 10
to 15 minutes can cause some persons to limit themselves to
staying at home.
The SSA Ruling states that in IC
cases "fatigue may affect the individual’s physical and
mental ability to sustain work activity (which means 8 hours a day
for 5 days a week or the equivalent). The problem of urinary
frequency may make it particularly difficult to maintain a full
time job due to constant trips to the bathroom.
While IC can be a very
debilitating disease the fact that the SSA has now issued a ruling
giving guidance on evaluating IC for disability purposes is a
positive step in helping person’s life who is suffers from this
condition. The award of Disability Insurance Benefits can provide
a safety net of a monthly income and eventual Medicare coverage
for medical and hospital bills for a successful disability claim.
Notice: Since Social
Security Disability is directed under Federal law, the information
in this column will apply anywhere in the United States.
However each Office of Hearings and Appeals and District Office
have their own ways of doing things as does the various Federal
District and Circuit Courts. I have kept this column
primarily dealing the the mechanics of how the Social Security
District Offices and Office of Hearings and Appeals evaluates
disability claims.
- Pitt Dickey
Pitt Dickey has practiced law
in Fayetteville since 1978. He has handled SSA disability claims
for over twenty years. He practices with the firm of Smith,
Dickey, Smith, Hasty & Dempster, P.A. at 555 Executive Place
and can be reached at 910-485-8020 or at pitt@smithdickey.com
. Or at the firm web site of www.smithdickey.com
.
Copyright © 2002 Pitt Dickey -
Used with permission
