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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 SSAís 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 physicianís 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 individualís 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 personís 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 individualís claim because the individualís IC does not meet or medically equal a listing." If a claimantís 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 individualís 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 personís 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

 

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