The National Organization of Social Security Claimants Representatives (NOSSCR), recently published an article about compassionate allowances by the Social Security Administration for claimants suffering from autoimmune diseases:
Impairments that are on SSA’s list of Compassionate Allowances are those that provide almost a 100% guarantee that the person will be found disabled. Individuals with these conditions are not expected to improve. If a claimant is diagnosed with one of these conditions, an approval is generally issued within two weeks.
To determine which impairments should be on this list, SSA has held several hearings on various medical conditions. On March 16, 2011, SSA heard from several experts in the field of autoimmune diseases at an outreach hearing in Baltimore, MD. Doctors specializing in each of these individual conditions spoke at the hearing, as did a doctor from Johns Hopkins Center for Autoimmune Disease Research, several advocacy groups and individuals living with some of these conditions. Some of the more common autoimmune diseases are rheumatoid arthritis, lupus and scleroderma. This is a difficult classification as there are over 100 autoimmune diseases that share some common impairments, but that also each have their own differentiating features and may affect one individual differently than another. All are caused by the body’s autoimmune response to one’s own tissue, cells and organs. Many people suffer from more than one autoimmune disease. For example, 95% of people who suffer from lupus also have arthritis, but the two conditions are not the same.
Commissioner Astrue opened the hearing by explaining that the purpose was to learn more about the functional limitations caused by autoimmune diseases and then determine whether the confirmation of a diagnosis alone can meet a compassionate allowance definition of disability. SSA is seeking information on what an adjudicator with no medical training can look for in an autoimmune disorder that would almost guarantee a finding of disability. One problem is that there is not enough research done on many of the autoimmune diseases to have highlighted an objective marker. ODAR Deputy Commissioner Glenn Sklar questioned the accuracy of a diagnosis made by a general practitioner. Many patients do not have access to specialists, but because many autoimmune disorders are rare, a general practitioner may not be familiar with all of the symptoms, and may not make an accurate diagnosis. Because a compassionate allowance will be made on the basis of a diagnosis, it is important that the diagnosis can be reliable. Diagnoses made by specialists are more reliable.
A striking similarity of all of these conditions is the number of organs they affect. A person with a primary diagnosis of lupus may also have pulmonary fibrosis, digestive disorders or cardiac impairments. People with rheumatoid arthritis have an increased chance of heart attack and stroke. In addition, although none are curable, all are more treatable when diagnosed earlier. So an individual whose treatment began soon after symptoms surfaced may be less disabled than one with less access to medical care who may not have begun treatment until the symptoms were much more advanced.
Many of the speakers focused on the combination of impairments. For example, the President of the Lupus Foundation of America explained that there were four organ combinations affected by lupus that she felt were most likely to result in disability: 1) brain and nervous systems, which lead to seizures, psychosis, severe headaches and movement disorders; 2) heart and lungs, which cause pulmonary embolism and hypertension, myocardial infarction and lung diseases; 3) muscles and joints causing limitations in mobility, avascular necrosis and rheumatoid arthritis; and 4) kidney involvement that can lead to the need for dialysis and transplants. Other autoimmune disease combinations can lead to similar problems.
The individuals with these diseases spoke of their struggle to remain in the workforce as their conditions progressed to the point of disability. They explained the extreme fatigue they experience everyday, the difficulty in doing the simple daily activities and the debilitating side effects of medication needed to keep the primary impairments under control.
The speakers’ handouts are available online at www.ssa.gov/compassionateallowances. The material includes useful information about each of these conditions for attorneys who are representing clients with the specific condition. There is information about how several organs can be affected and some very graphic pictures of the debilitating effects of these conditions.
There are currently 88 conditions on the Compassionate Allowances list. This list, as well as information about how SSA processes claims involving these conditions, can be found at www.ssa.gov/compassionateallowances.