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ICD-9 Codes / Diagnosis

Discussion in 'Finances, Work, and Disability' started by August59, Apr 25, 2011.

  1. August59

    August59 Daughters High School Graduation

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    Upstate SC, USA
    Is the ICD-9 codes the determining factor when it comes to disability (or any other reason I geuss)?

    In general terms, does an ME diagnosis carry more wieght than a CFS diagnosis?

    Is there more than one code for a specific disease/condition?

    Thanks
  2. Tammie

    Tammie Senior Member

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    Woodridge, IL
    In the US, ME is not recognized as a diagnosis; however, as far as disability goes, if you are talking about SSDI, then the diagnosis techincally does not really matter anyway. (If you mean other forms of dis I have no idea.)

    Re SSDI, it is supposed to be all about how limited your ability to function is, regardless of the disgnosis (that said, there is definitely some disgrimination against certain diagnoses if they are hard to prove and/or people do not believe they even exist, and unfortuantely CFS is one diagnosis that many tend to disbelieve). They are supposed to determine your ability to work based on drs notes, what you report yourself, what frineds/family/co-workers, etc report about your functioning, and sometimes by making you take various tests that a re supposed to show if you can function well enough physically, cognitively, and/or emotioanlly to be able to work.
  3. August59

    August59 Daughters High School Graduation

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    Upstate SC, USA
    Thanks Tammie - I was curious about the diagnosis codes because my CFS doc had put down 4 or 5 different codes down in my chart. You answered another question I had about how much they meant as compared to actual physician notes. I'm listing my other "diagnosis" (not icd-9) from physicians before ME/CFS for the reasons you mention. The only reason I am listing it is that my CFS doc agrees with me going on disability along with my neurologist and orthopedic docs.

    Thanks again
  4. Sushi

    Sushi Moderator and Senior Member Albuquerque

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    My doc usually puts about 5 related codes on things. I think this is mostly to get the best shot at insurance covering it.

    Sushi
  5. MEG

    MEG Senior Member

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    @ Tammie, great explanation.

    Regarding disability, in general the more (number of) diagnoses listed the better. EVERYTHING counts....even things like frequent urination or chemical/environmental sensitivities (reaction to florescent lighting) as silly as that sounds. And don't ever negate the psychological issies. Depression, anxiety, Panic attacks....that all adds up to not being able to work. I actually did an EXEL spreadsheet and a daily diary for 2 years. The spreadsheet involved numbers of steps taken, hours of sleep, pain level, anxiety etc. Document, document, document and document more! "If it isn't documented, it didn't happen"...nursing phrase!

    And don't wait too long to start the process....as I did. I just couldn't face the fact that I wasn't going to be an energetic, compassionate RN anymore...I WAS going to get well I told myself. Dumb, with a capital B!

    ~M
  6. WillowJ

    WillowJ Senior Member

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    WA, USA
    for SSA, depression and other conditions are supposed to be helpful. However be aware that some other insurances write exclusions for "mental" conditions and inexplicably limit coverage to 2 years. So know your insurance before deciding what diagnoses to include in your complaint.

    unfortunately, the tests they do to determine disability are like this illustration... you come across someone looking under a street lamp for a lost penny and join the search (it's a rare penny). After a while when the search continues to prove fruitless, you ask where the penny was dropped. "Oh, several yards up the street," is the reply. "Why on earth are we looking here," you ask. The searcher answers, "Easy. The light is better here."
  7. medfeb

    medfeb Senior Member

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    Not sure if it will be helpful to you, August59, but there was a presentation and quite a bit of discussion on disability at the recent CFSAC meeting. Look at the day 2 video in the morning. I am not sure exactly what time it starts but the speaker was John Federline.

    http://nih.granicus.com/ViewPublisher.php?view_id=26
  8. Sue C

    Sue C Sue C

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    NJ
    MEG, Am another RN. worked until longest I could keep a job was the initial two week stage orientation. Then quit on my own due to physically dropping items or realizing slower response time should not apply to position. By that time was only a part timer and SSDI goes back @ 10 work quarters so amount based on is much lower than 'healthy' retirees. It did not prove much but make me too sick to work at anything/ even returned to college to try another medical career and graduated! So l can understand the 'Florence' thing. Who knew this would be such a complex, long term sentence. But am usually a glass half full person and try to accept as Cheney told me to be a human be-ing no do-ing! Better quit reading as am weary already.SueC
  9. CJB

    CJB Senior Member

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    I just pulled this excerpt from the caption notes - very interesting.

    EVALUATION: IS THE CLAIMANT ENGAGING IN SUBSTANTIAL GAINFUL ACTIVITY?

    ARE THEY PARTICIPATING IN WORK ACTIVITIES THAT GENERATE AT LEAST $1,000 A MONTH?

    IF THEY ARE THEN THE CLAIM WOULD BE DENIED AND WE WOULD NOT MOVE ON TO STEP 2.

    IF THEY HAVE NOT, THEN WE NEED TO LOOK AT THE SIGNS, SYMPTOMS AND MEDICAL FINDINGS, TO DETERMINE IF THERE IS A MEDICALLY DETERMINED IMPAIRMENT.

    WE ARE AT STEP 2, IF WE FIND THERE IS A MEDICALLY DETERMINED IMPAIRMENT, WE HAVE TO ASSESS THE EVIDENCE WE RECEIVED, IS THE IMPAIRMENT SEVERE?

    ONE THING THAT HELPS TO BE A CONSISTENT PROCESS, THE MORE THE CLAIMANT REPRESENTATIVE SUPPLIES ALLEGATIONS AND OR MEDICAL REPORTS OR MEDICAL SOURCES THAT SUPPORT THEIR ALLEGATIONS, THE SOONER THE ADJUDICATOR CAN MAKE A DECISION AS TO WHETHER THE PERSON IS/IS NOT DISABLED.

    IF THEY ARE ALLEGING CFS, FOR EXAMPLE, IF THEY ALLEGE CFS AND THE MANIFESTATIONS ALSO, THAT THEN MEANS FROM THE SEQUENTIAL EVALUATION PROCESS, ALL THOSE MANIFESTATIONS NEED TO BE INVESTIGATED CLOSELY TO MAKE AN ACCURATE AND TIMELY DECISION.

    FRIO IF THEY ARE FOUND SEVERE, THEN WE MOVE ON TO STEP THERE, DOES THE CLAIMANT MEET, MEDICAL LISTINGS, AS I SAID, I WORK IF THE OFFICE OF MEDICAL LISTINGS IMPROVEMENT, DO THEY MEET THE CRITERIA FOR ONE OF THOSE LISTINGS, DO THEY EQUAL THE SEVERITY OF THOSE LISTINGS?

    IF YOU TAKE, FOR EXAMPLE, CHRONIC FATIGUE SYNDROME, IF THERE IS NO LISTING RIGHT NOW FOR CHRONIC FATIGUE SYNDROME AND THERE REALLY IS NO WAY FOR US TO PUT EVERY IMPAIRMENT INTO WHAT WE CALL THE BLUE BOOK OR MEDICAL LISTINGS OF IMPAIRMENT.

    FOR IMPAIRMENTS NOT IN THAT BOOK STHERE A LISTING THAT ESTABLISHES THE SEVERITY SIMILAR TO WHAT CFS MIGHT BE IN ITS GREATEST -- ACTUALLY THE WORST STAGE THEY WOULD HAVE.

    IF IT IS, THEN THEY WOULD EQUAL THE SEVERITY OF THAT LISTING.

    AT THAT POINT, IF THEY DO THE RED BOX WHICH IS HARD TO READ SHOWS THEY ARE DISABLED.

    WEP DON'T NEED TO MOVE ON TO THE NEXT STEP.

    EACH ONE OF THE STEPS HAS A YES/NO ANSWER.

    IT IS NOT A SIMPLE YES/NO ANSWER.

    WE NEED TO GET AS MUCH EVIDENCE AS WE CAN TO MAKE SURE WE ARE BASING THESE DECISIONS ON FINDINGS OF FACTS AND ANALYSIS OF EVIDENCE.

    FROM STEP 3, IF THEY DO NOT MEET OR EQUAL, THEN WE MOVE ON TO STEP 4.

    NOW WE ARE GETTING INTO A MORE COMPLEX PROCESS, NOT ONLY ARE WE CONSIDERING THE AFFECTS OF THE MEDICAL IMPAIRMENT AND ALL THE EVIDENCE THAT HAS BEEN SUPPLIED TO SUPPORT THE SEVERITY OF THAT IMPAIRMENT.

    SINCE IT DOES NOT MEET OR EQUAL, HOW SEVERE IS IT.

    HOW MUCH FUNCTION HAS BEEN TAKEN AWAY FROM THAT INDIVIDUAL?

    HOW MUCH REMAINING FUNCTION DO THAT HAVE?

    AT THIS POINT THE PHYSICIANS AND THE OFFICES THAT ADJUDICATE THE CLAIMS WOULD FILL OUT A FUNCTIONAL RESIDUAL FUNCTION OF CAPACITY ASSESSMENT.

    AN RFC.

    WE HAVE TO GET A HISTORY OF THE WORK.

    HOW LONG HAVE THEY PERFORMED IT?

    IT WOULD NOT BE CONSIDERED PAST RELEVANT WORK.

    ALL THESE DIFFERENT CONSIDERATIONS THAT NEED TO BE TAKEN INTO ACCOUNT.

    MORE COMPLEX THE FURTHER DOWN WE GO.

    IF A CLAIM HAS ENOUGH EVIDENCE, THOSE DECISIONS ARE MADE FASTER THAN WHEN YOU GET DOWN TO STEP 4.

    AT STEP 3, IF YOU HAVE ENOUGH EVIDENCE TO SUPPORT THE FUNCTION OF THE CLAIMANT TO MEET/EQUAL, THAT DOESN'T REQUIRE ENOUGH EVIDENCE WHEN YOU GET TO STEPS 4 AND 5 OF THE SEQUENTIAL EVALUATION PROCESS.

    AT THAT POINT YOU HAVE TO START ESTABLISHING THE VOCATIONAL EVIDENCE AND COMPARE THAT WITH THE MEDICAL EVIDENCE TO SEE HOW MUCH FUNCTIONAL CAPACITY REMAINS AND WITH THAT FUNCTIONAL CAPACITY, CAN THEY DO WORK THEY HAVE DONE IN THE PAST.

    THEY CANNOT RETURN TO THEIR PAST WORK.

    NOW THE ADJUDICATOR HAS TO GO 1 STEP FURTHER AND SAY OKAY, DO THEY HAVE THE CAPACITY TO DO OTHER WORK?

    FIRST OFF, THEY HAVE TO ESTABLISH WHAT OTHER WORK CAN THEY DO?

    WHAT TYPE OF TRANSFERABLE SKILLS DO THEY HAVE FROM THE WORK THEY HAVE DONE TO OTHER WORK?

    WHAT IS THERE AGE? WHAT IS THE EDUCATION THEY HAVE?

    ALL THESE ENTER INTO WHETHER THE PERSON WOULD BE DISABLED AT THIS STEP OF THE EVALUATION.

    WITH ALL THAT EVIDENCE ANALYZED AND CONSIDERED, IF THEY DECIDE THAT THEY WOULD BE ABLE TO RETURN TO OTHER WORK, THEN THEY WOULD MAKE A DESESSION OF NOT DISABLED.

    IF THEY DETERMINE THAT THE FUNCTIONAL CAPACITY REMAINING PREVENTS THEM FROM GOING TO OTHER WORK OR THERE IS INSUFFICIENT OTHER WORK THAT THEY COULD TRANSFER THEIR SKILLS TO, THEY WOULD MAKE A DECISION OF DISABLED.

    THAT IS A VERY BRIEF DESCRIPTION OF THE 5-STEP ANALYSIS OF SOCIAL CLAIMS CH I HAVE BEEN WORKING ON IT FOR 38 YEARS AND COULD GO INTO EXPLAINING THIS FOR OVER SEVERAL DAYS.

    THIS IS A REAL QUICK ANALYSIS OF THAT.

    >> IT RECOGNIZES HAVING THE SEVERITY AND GOES TO DISABLED.

    >> THE BLUE BOOK, THEY WOULD HAVE SPECIFIC FINDINGS THAT IF THE MEDICAL EVIDENCE MATCHES UP WITH THOSE FINDINGS, WE CALL THAT MEETS.

    >> THEN WHAT, WHAT IS CFS COMPARED TO, DO YOU KNOW?

    THEY DON'T FIND CFS IN THE LISTING, WHAT ARE THEY LOOKING AT AS COMPARABLE?

    >> ANY OF THE NEUROLOGICAL DISEASES, IMMUNE DISEASES, WHATEVER THE IMPACT OF THE MANIFESTATIONS ARE.

    IF THE MANIFESTATIONS IMPACTED ON SAY WALKING, STANDING, OVER A LONG PERIOD OF TIME AND SOMETHING IN ONE OF THE OTHER LISTINGS THAT MATCHES THAT, THEY WOULD MATCH THE EVIDENCE TO THAT.

    >> WOULDN'T IT MAKE SENSE TO PUT A CHRONIC FATIGUE SYNDROME IN THE BLUE BOOK?

    BECAUSE THEY ARE REALLY NOT NEATLY FIT UNDER THE OTHERS BECAUSE OF THE WAY -->> AS I SAID, THERE ARE SO MANY IMPAIRMENTS, THEY HAVE TO TRY TO FIT THE ONES IN THERE THAT THEY CAN.

    IT IS NOT THAT THEY AREN'T CONSIDERING THAT. BUT RIGHT NOW, WITH THEM NOT HAVING IT IN THE BLUE BOOK, THIS IS HOW THEY WOULD EVALUATE THOSE CLAIMS.

    >> THANK YOU.

    >> QUICK QUESTION: ABOUT A DECADE ABOUT, I GAVE A TALK TO THEM IN NEW YORK -->> DO THEY RECEIVE SOME KIND OF -->> THE SSR IN THE NEXT PART OF MY TALK IN TERMS OF HOW TO EDUCATE ALL EDUCATORS ON WHAT CFS, IF THE CLAIMANT OR REPRESENTATIVE PUTS THEM INTO THE ALLEGATIONS, IT ALSO EMPHASIZES POINTS THAT SHOULD BE CONSIDERED ON THOSE CLAIMS.

    >> COULD YOU ALSO TAKE EVIDENCE USED TO SUBSTANTIATE DISABILITY IN ANOTHER ILLNESS, WOULD THAT BE A REASONABLE ARGUMENT?

    >> ABSOLUTELY. >> WOULD IT BE, IF THIS PARTICULAR GROUP, THIS IS THE CHRONIC FATIGUE SYNDROME ADVISORY COMMITTEE, CFS, WOULD THAT BE SOMETHING THAT COULD INFLUENCE YOUR AGENCY TO CONSIDERED CREATING A CATEGORY?

    >> WE CONSTANTLY HAVE ALL ADVOCACY GROUPS APPROACH US ABOUT THAT SAME ISSUE.

    WHEN WE ARE REWRITING LISTINGS, IF ONE OF THOSE IMPAIRMENTS FITS IN AND CAN ADD THEM IN, WE DO CONSIDER THAT.

    WE ARE IN THE PROCESS OF REWRITING LISTINGS OVER A 5-YEAR PERIOD.

    THEY ARE REGULATIONS AND THEY HAVE TO BE VETTED THROUGH ADVOCACY GROUPS AND OTHER AGENCIES TO SEE WHAT IMPACT THOSE CHANGES WOULD MAKE.

    YES, WE DO CONSIDER THOSE TYPES OF THINGS.

    >> I HAVE A QUESTION, THINKING ABOUT MY OWN SITUATION, YOU HAVE TO FIRST OF ALL, HAVE ESTABLISHED YOU WERE MAKING AT LEAST $1,000, IS THAT A MONTH?

    NEW IN YES.

    >> WHAT IF YOU CAN'T WORK FULL TIME, BUT PART TIME, WOULD THAT MEAN YOU ARE PARTIALLY DISABLED?

    IT IS ALL OR NOTHING. >> THERE IS NO PARTIAL DISABILITY IN SOCIAL SECURITY.

    IT IS 100 PERCENT.

    ALL THE WORK ISSUES WOULD BE ADDRESSED.

    THEY HAVE A WHOLE DEPARTMENT THAT LOOKS AT THE ISSUES THAT DETERMINE THE IMPACT SO A PERSON WORKING PART TIME WHO MAY HAVE ALWAYS WORKED PART TIME, THAT MAY HAVE ENTERED INTO THE STEP 4, STEP 5 DECISION.

    THAT IS ALSO ENTERED INTO THE DECISION?

    >> IF YOU TAKE THOSE CONSIDERATIONS IN.

    SUBSTANTIAL GAINFUL ACTIVITY, SORRY, STEP 1.

    >> JOHN, DOES THE SSA GIVE A PRECISE CRITERIA FOR AN ILLNESS TO BE CONCLUDED IN THE BLUE BOOK?

    >> NO.

    THERE ARE POLICY EXPERTS IN SOCIAL SECURITY THAT LOOK AT THE TYPES OF IMPAIRMENTS.

    THEY CONSIDER, LIKE WE JUST TALKED TO 3 OTHER ADVOCACY GROUPS THIS PAST MONTH ABOUT THEM WANTING TO HAVE THEIR IMPAIRMENT PUT IN THE BOOK, TOO.

    IT REALLY DOESN'T IMPROVE THE CHANCES OF A PERSON BEING FOUND DISABLED.

    IT JUST MEANS IT IS MORE TO THE FOREFRONT.

    BUT THE EQUALS PART IN THE EDUCATION WE ARE GOING TO TALK ABOUT FOR THE ADJUDICATORS.

    THE ADJUDICATORS WOULD LOOK FOR SIMILAR FINDINGS AND LISTINGS THAT WOULD APPROXIMATE WHAT CFS PATIENTS HAVE.

    THAT IS THE 5-STEP PROCESS. THEN WE MOVE ON TO THE SECOND ITEM WE HAVE, THE SOCIAL SECURITY RULING 99-2P.

    SSA WANTS TO MAKE SURE OUR ADJUDICATORS ARE ON THE SAME PAGE AND HOW THAT IMPAIRMENT EFFECTS HIS OR HER FUNCTION TO WORK.

    WE CAME OUT WITH DETAILED INSTRUCTIONS FOR EVALUATING ME/CFS CLAIMS AND INCLUDED IN THIS RULING.

    ONCE THE ADJUDICATOR DETERMINES THE CLAIM AN MEI, WE WORK OUR WAY THROUGH THE 5-STEP PROCESS.

    YOU CAN FIND THIS RULING AT THIS WEBSITE, I BELIEVE THIS WEBSITE IS AVAILABLE TO THE PUBLIC AND ME/CFS COMMITTEE.

    WE HAVE TO ASSURE ALL ADJUDICATORS HAVE TO APPLY ALL PROVIDED TO THEM AND THE 5-STEP PROCESS.

    WE HAVE PROVIDED TEXT RESOURCES.

    THE DISABILITY EXAMINERS HAVE SA BASIC EXAMINER TRAINING GUIDE EVALUATING THE CFS CONDITION AND SHOW EXAMPLES OF MANUALS AND HANDBOOKS AVAILABLE TO DOCTORS AND ADJUDICATORS IN THE SSA PROCESS.

    AGAIN IT IS TO HELP ADJUDICATORS EVALUATE CLAIMS CONSISTENTLY.

    THESE ARE AVAILABLE IN PAPER FORMAT AND ONLINE.

    THE ADJUDICATORS CAN, BY GOING TO THE INTERNET CAN ACCESS THESE TRAINING MANUALS AT ANY TIME.

    IT GIVES THEM A CHANCE TO GO TO LINKS THAT ARE ASSOCIATED WITH THE TEXT IN THE BOOK.

    >> WITHOUT JUMPING TOO FAR AHEAD, WE SEE A SPECIFIC COMPONENT OF THIS DESCRIPTION APPLY TO A GIVEN PATIENT , IS THAT A BENEFIT TO THE ADJUDICATOR.

    >> ANYTHING THEY CAN INCLUDE IN THEIR ANALYSIS WOULD BE HELPFUL.

    >> DO YOU TRAIN THE ADJUDICATOR TO DO THAT?

    >> YES. CONSISTENTLY THROUGHOUT THE COUNTRY, I HAVE HAD THE OPPORTUNITY WHEN SOCIAL SECURITY WENT FROM PAPER FOLDERS TO ELECTRONIC FOLDERS.

    WHEN THEY MOVED FROM PAPER TO ELECTRONIC --

    FOLDERS, IN ORDER TO DO THAT, SOCIAL SECURITY USED THE PAPER FOLDERS AS WELL AS ELECTRONIC.

    I WAS VERY PLEASED TO SEE HOW CONSISTENT THEY WERE IN THE APPLICATION OF THE POLICY THROUGHOUT THE COUNTRY.

    >> SORRY FOR INTERRUPTING YOUR PROCESS.

    SOMETIMES WHAT IS ON THE BOARD BRINGS UP QUESTIONS.

    SOCIAL SECURITY IS VERY OFTEN THE ONLY LIFELINE THEY HAVE.

    WHEN THERE IS A PRIVATE DISABILITY POLICY, ALL PRIVATE DISABILITY PROCESS MAKE THE PATIENT GO THROUGH THE SOCIAL SECURITY PROCESS.

    I OFTEN HAVE PEOPLE 200 PERCENT DISABLED INSTEAD OF BEING, 100 PERCENT FOR CHRONIC FATIGUE SYNDROME THERE WILL BE 40 PERCENT FOR DEPRESSION, 15 PERCENT FOR THE FOOD THEY CAME BACK FROM IRAQ INJURIED AND ADD UP TO A LOT MORE THAN 100 PERCENT.

    WHEN YOU GO BACK TO THE PRIVATE DISABILITY PEOPLE, THEY START, THE PATIENTS LOSE THEIR COVERAGE AFTER 2 YEARS BECAUSE IT IS A MENTAL CONDITION LISTED ON THEIR SOCIAL SECURITY APPROVAL.

    WITHOUT ANY UNDERSTANDING AND THAT PROCESS, THAT MIGHT HAVE BEEN 2 OR 5 PERCENT OF THE OVERALL JUDGMENT.

    DISTINGUISHED BETWEEN PHYSICAL AND MENTAL AS THEY DID IN THE PRIVATE DISABILITY INDUSTRY AND JUST BECAUSE SOCIAL SECURITY INCLUDED THAT, AND SOMETIMES THE CLINICIAN REALLY STICKS IT IN THERE BECAUSE THE PATIENT DESPERATELY NEEDS THE INCOME AND MIGHT AMP IT UP.

    IN THE END THESE PEOPLE LOSE PRIVATE DISABILITY COVERAGE, ASSOCIATE SECURITY IS A PART OF THEIR OVERALL DISABILITY DECISION.

    THAT IS A HUGE PROBLEM. IT IS A MASSIVE PROBLEM.

    IN AN EFFORT TO DO RIGHT BY THESE FOLKS, SOCIAL SECURITY ADMINISTRATION -- AND BE 100 PERCENT DISABLED WHICH THEY ARE, WHICH I TOTALLY AGREE WITH.

    THE WAY THE PRIVATE DISABILITY INSURANCE WORKS IS QUITE DIFFERENT, ULTIMATELY, THE SOCIAL SECURITY DISABILITY HURTS THE PATIENT 2 YEARS LATER.

    IN THE VA, I'LL SAY LOOK, THEY WERE 180 PERCENT ON PHYSICAL AND ONLY HAD 20 PERCENT ON MENTAL, HOW CAN YOU DENY THEM.

    THIS HAS BEEN DONE THIS WAY.

    I AM CURIOUS, ANY WAY THE PATIENTS COULD HAVE ANYTHING TO FALL BACK ON AND WHAT THEY RECEIVE THE SOCIAL SECURITY, 2 YEARS LATER HAVE THE RUG PULLED OUT FROM UNDERNEATH THEM.

    IS THERE ANY WAY TO BREAK UP FROM THE RULING WHAT PERCENT IS WHAT?

    >> NONE.

    >> SOCIAL SECURITY LOOKS AT THE WHOLE PERSON.

    IF MENTAL IS PART OF THAT WHOLE PERSON DECISION.

    THEY WOULD NOT HAVE TO ENTER THE SECONDARY IMPAIRMENT.

    >> WHAT HAPPENS A LOT OF TIMES, THEY WRITE A SUMMARY PARAGRAPH IN A RULING TO SAY THEY HAVE ALL THESE PHYSICAL CONDITIONS AND MENTAL HEALTH CONDITION.

    IF THE DISABILITY POLICY SAYS CAUSED OUR CONTRIBUTED BY A MENTAL HEALTH CONDITION, THEN THEY LOST THEIR PRIVATE POLICY WHICH IS OFTEN TIMES MORE VALUABLE THAN THE SOCIAL SECURITY BENEFIT.

    IT IS, IT IS A PROBLEM THAT I SEE IN MY PRACTICE EVEN THOUGH I DON'T REPRESENT PEOPLE WITH SOCIAL SECURITY CLAIMS.

    >> THEY CAN STOP THERE, REALLY, IF THEY FIND THE CHRONIC FATIGUE SYNDROME IS DISABLING, THEY ARE STOPPING AT AN EARLIER STEP NOT GOING THROUGH THE SAME -- I THINK THE WITH THE 99-2P, YOU HAVE A REAL START.

    >> IF SOME OF THEIR IMPAIRMENT CONTRIBUTES TO IT WITH CFS, SUCH AS THE MENTAL IMPAIRMENT, THE WHOLE PERSON HAS TO BE CONSIDERED.

    IT STILL WOULD BE THERE EVEN IF IT IS IN THE BLUE BOOK.

    >> I DON'T THINK IT WOULD BE THE SAME WAY THOUGH, BECAUSE IF YOUR FATIGUE IS YOUR PRIMARY DISABLING SYMPTOM AND MAYBE YOU CAN'T GET UP AND GO TO WORK 5 DAYS A WEEK BECAUSE MONDAY OR WEDNESDAY, WHATEVER, SOMETHING LIKE THAT, IF THOSE ARE THE CRITERIA, THEN THEY STOP THERE.

    IF I AS THE REPRESENTATIVE OR DISABLED PERSON DON'T PUT ANY MENTAL HEALTH IN, THEY'LL STOP THERE.

    HOWEVER, IF THEY ARE LOOKING AROUND ON A LIST FOR DIFFERENT IMPAIRMENTS, THAT MIGHT ONE CAUSE INCONSISTENCY IN THE RULINGS BECAUSE SOME FIND THINGS AND SOME DON'T.

    AND SECONDLY, CREATES AN OPPORTUNITY FOR ADDING CONDITIONS UP TO GET TO DISABILITY.

    JUST A THOUGHT.

    >> WE HAVE A SCHEDULE, I AM GOING TO TRY TO KEEP THE BEST WE CAN.

    JOHN WILL YOU BE AVAILABLE FOR THE WHOLE MORNING? >> YES. WE'LL TAKE OUT COMMITTEE DISCUSSION TIME, I SUGGEST, IF YOU HAVE QUESTIONS FOR JOHN, WRITE THEM DOWN.

    HE'LL GIVE US TIME THE ANSWER THOSE QUESTIONS.

    A LOT OF IMPORTANT ISSUES TO DEAL WITH.

    WE HAVE THE ERISA PRESENTATION. I AM GOING TO LET JOHN, FINISH HIS PRESENTATION, WE'LL HEAR THE NEXT ROUND OF PRESENTATIONS AND HOPEFULLY THAT GROUP WILL STAY FOR QUESTIONS IN THE END.

    THANK YOU, JOHN. IN ADDITION TO THE SECTION RESOURCES, THIS IS THE SITE YOU WOULD GO TO, IT IS PUBLICALLY ACCESSIBLE. I DIDN'T PUT UP HERE WITH A HALIX, THAT IS THE HEARINGS OFFICE EQUIVALENT OF PALMS, FOR LAW JUDGES TO USE, AND EXAMPLE, IF HE NEEDED TO ACCESS THE PALMS, THIS IS THE SITE THAT YOU WOULD GO TO, IT IS PUBLICALLY ACCESSIBLE AND SOME EXAMPLES ARE DI225-5.10 AND MEDICAL AND OTHER EVIDENCE OF INDIVIDUAL'S IMPAIRMENT.

    THE SECOND BULLET ON THE SLIDE PROVIDES CHAPTER NUMBER AND THE COUPLE WITHIN THE PALMS.

    AGAIN THIS MANUAL HELPS ALL ADJUDICATORS HAVE THE SAME INFORMATION FOR EVALUATING ME/CFS.

    EVERY ADJUDICATOR IS APPROACHING THE ME/CFS CLAIMS IN THE SAME WAY.

    WE HAVE BEEN ABLE TO SET UP A VIRTUAL REVIEWER.

    THEY CAN REVIEW CLAIMS FROM ANOTHER PART TO ASSURE THE CLAIMS ARE BEING ADJUDICATED IN THE SAME WAY.

    THEN MAKE SURE THAT THE DECISION WAS CORRECT.

    SO IT REALLY GIVES US AN ADVANTAGE THROUGHOUT THE COUNTRY TO SEE SOMEONE IN BOSTON CAN REVIEW A CLAIM IN CALIFORNIA AND SEE IF THE ADJUDICATORS THERE ARE DOING THE CLAIMS THE SAME WAY THEY ARE IN THE NEW ENGLAND AREA.

    AND THAT THEN, UM, SO THOSE ARE THE 5

    WAYS THAT SOCIAL SECURITY ASSURES THE

    CONSISTENCY IS DONE NOT ONLY ON CFS

    CLAIMS BUT ANY IMPAIRMENT A CLAIMANT MIGHT ALLEGE.

    WE ALSO USE OTHER SOURCES SUCH AS WHEN

    AND HOW WOULD CONTROLLING WEIGHT BE

    GIVEN TO THE TREATING PHYSICIAN?

    CONSIDERING PAIN AND OTHER SYMPTOMS IN DETERMINING MDI.

    WHEN MEDICAL SOURCE OPINIONS ARE RESERVED TO THE COMMISSIONER OF SOCIAL SECURITY.

    EVALUATING SYMPTOMS, ASSESSING CREDIBILITY OF THE CLAIMANT OR

    REPRESENTATIVE, DETERMINING THE RESIDUAL

    CAPACITY AND DETERMINING CAPABILITY FOR

    OTHER WORK.

    SOME ADDITIONAL RESOURCES, SUPPLY FACT

    SHEETS TO TREATING SOURCES AND OTHER

    SOURCES TO LET THEM KNOW WHAT SOCIAL

    SECURITY IS LOOKING FOR AND WHEN A

    CLAIMANT HAS FILED FOR THE SYNDROME AND

    HELPFUL ITO PROVIDE FOR THEM IN FILING

    CLAIMS. WE HAVE A QUESTION/ANSWER AREA

    ELECTRONICALLY, THAT HELPS ADJUDICATORS

    TO ASK THAT QUESTION AND HAVE A NATIONAL

    POLICY RESPONSE TO THOSE QUESTIONS.

    THAT IS SOCIAL SECURITY PROMOTES

    CONSISTENCY.

    >> ONE QUICK QUESTION, THEN WE WILL HAVE

    THE ERISA THE PRESENTATION AND MORE

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