Hemophilia and Qualifying for SS Disability Benefits
Can I get disability benefits if I am suffering from the effects of Hemophilia?
Author: Attorney Lonnie Roach
Approximately 400 babies are born in the United States with hemophilia A each year. Hemophilia primarily affects males, and the exact number of people living with hemophilia is not known, but there may be as many as 33,000 males with the disorder in the U.S. If you are suffering from the effects of Hemophilia you may qualify for disability benefits.
Hemophilia is a rare disorder in which the blood doesn’t clot normally.
Normally, the body pools blood cells to form clots to stop bleeding; clotting factors are proteins in the blood which work with cells to form clots. When these clotting factors are low, or missing, hemophilia occurs. A person who has hemophilia may bleed longer after an injury than other individuals whose blood is clotting normally. Small cuts may not be a problem, but severe forms of the disorder can cause internal bleeding, which can damage organs and tissues and be life-threatening. Hemophilia is almost always a genetic disorder, though approximately one-third of cases have no family history.
There are three types of hemophilia.
Hemophilia A, also called classic hemophilia, is caused by a missing or defective clotting protein called factor 8. Hemophilia B is caused by a missing or defective clotting protein called factor 9. Hemophilia B is four times less common than hemophilia A. Some individuals develop hemophilia who have no family history of the disorder. This type is known as acquired hemophilia and occurs when an individual’s immune system attacks clotting factor 8 or 9 in the blood. Acquired hemophilia can be associated with autoimmune conditions, cancer, multiple sclerosis, pregnancy or a reaction to drugs.
If you are suffering from Hemophilia and have been denied disability don’t give up, almost 70% are denied initially! Just call 512-454-4000 for a free, no obligation consultation to learn what your options are. Have some questions? just give us a call, we love to help folks just like you!
Hemophilia is often diagnosed in the first year of life, but many people may not exhibit symptoms until much later.
These symptoms vary, depending upon the level of clotting factors in an individual’s blood. If clotting is reduced mildly, a person may only bleed after surgery or a trauma; if clotting factors are extremely low, they may bleed for no reason at all.
- unexplained and excessive bleeding;
- nosebleeds for no known cause;
- unusual bleeding after vaccinations;
- many deep, large bruises;
- pain, swelling and tightness in joints;
- blood in stool or urine;
- in infants, unexplained irritability.
While individuals with mild cases of hemophilia may only bleed longer than normal, those with severe cases of hemophilia are at risk for serious complications, among them bleeding in the brain after a simple bump on the head, deep internal bleeding, damage to joints, infection and bleeding in the throat or neck, affecting breathing.
Currently there is no cure for hemophilia; treatment typically consists of intravenous injections of the deficient clotting factors. Sometimes exercises to increase joint strength are prescribed.
How do I qualify for SSDI with hemophilia?
People with hemophilia can be at risk for heavy blood loss.
In addition to bleeding after surgery or an injury, hemophilia can cause frequent nosebleeds, excessive menstrual bleeding, bleeding in the gums, and bleeding in joints, muscles and organs. Individuals with severe cases of hemophilia may be approved for Social Security Disability income if they can prove that hemophilia prevents them from doing any type of full-time work. Social Security’s Blue Book lists two impairments which qualify for disability benefits: Section 7.08, Disorders of thrombosis and hemostasis and Section 7.18, Repeated complications of hematological disorders.
To qualify under Section 7.08, Disorders of thrombosis and hemostasis, you must have complications of hemophilia that required hospitalization at least three times within a one-year period.
The hospitalizations must last at least 48 hours or longer and occur at least 30 days apart. Some complications that can result in hospitalizations include uncontrolled bleeding, anemia, embolisms or thrombosis.
If your hemophilia is managed by prophylactic factor replacement therapy, but you still experience episodes of bleeding and other symptoms that cause you to miss too many days of work, you may still qualify for SSDI under Section 7.18, Repeated complications of hematological disorders.
Examples of complications include anemia, pain, severe fatigue, joint and muscle swelling, limitation of joint movement, and cognitive or other mental limitations. In this case, you must prove that complications of hemophilia resulted in marked limitation in one of the following:
- performing daily activities; OR
- completing tasks in a timely manner because of problems in focus, pace or persistence, OR
- interacting with others in an appropriate manner.
If you don’t meet the requirements of either Section 7.08 or 7.18, Social Security will conduct a residual functional capacity (RFC) assessment, taking into consideration your age, education, work experience to evaluate how your limitations affect your ability to work.
For example, if you may potentially experience a dangerous bleed, you may not be able to return to your old job – or any job. The lower your RFC score, the more likely you will be approved for benefits. Social Security may decide that you can’t do your old job and may not expect you to learn a new job. Social Security follows a set of medical-vocational grid rules to determine when the agency expects an applicant to learn a new job. Applicants older than 50 or 55 often fall under a grid rule, which means they don’t have to learn a new job. If you’re unable to work at your old job or learn a new job, Social Security will likely grant you disability benefits. This is called a medical-vocational allowance.
Your condition must be verified by laboratory testing and you will be expected to provide objective medical evidence to support your claim including:
- relevant medical records;
- blood tests and other objective evidence;
- records of doctors’ visits; and
- doctors’ notes and detailed written opinions of treating medical providers regarding your limitations. Ask your doctor to complete an RFC form.
You should also include in your medical records any other medical conditions you may have; for example, asthma, or arthritis.
One disorder may not meet the requirements of a Social Security impairment listing, but if you have more than one medical condition, Social Security must consider how your combined health issues limit your ability to hold a job and perform routine tasks.
What are the basic financial requirements for SSDI?
Even if you meet all of Social Security’s requirements for hemophilia, you won’t be approved for SSDI unless you satisfy Social Security’s basic financial requirements:
1) you must have a disability that has lasted, or is expected to last, 12 months; 2) you must have worked long enough and recently enough in a job where you paid Social Security taxes to accumulate a certain amount of work credits; and 3) your income must not be more than Substantial Gainful Activity (SGA), which in 2022 is $1,350 per month for nonblind applicants and $2,260 per month for blind applicants.
How do I file for Social Security Disability benefits?
You can apply for Social Security Disability benefits online, over the phone, or in person at your local Social Security Administration office.
Don’t be discouraged because most initial applications are and you will have an opportunity to appeal.
There are four steps to the appeal process:
- File a Request for Reconsideration with the Social Security Administration to completely review your case again.
- If your request for hearing is denied, you can request a hearing before an Administrative Law Judge (ALJ). ALJs are attorneys who work for Social Security who review SSDI cases and either uphold or overturn decisions to deny SSDI benefits. If you are not represented by an attorney, you should obtain legal counsel at this critical point to raise your chances for success.
- If an ALJ denies your claim, you can request that the Appeals Council review your case.
- Federal Court review. The final step in the appeal process is filing suit in U.S. District Court.
What if I don’t qualify for SSDI?
If you haven’t worked long enough to accumulate enough work credits, you may be eligible for disability benefits through Social Security Income (SSI).
SSI is a program that pays monthly benefits to people with limited income and resources who are disabled, blind, or age 65 or older. SSI is based on income instead of work credits and is financed by general funds of the U.S. Treasury.
I have long-term disability insurance – should I file a claim?
Long-term disability insurance (LTD) is coverage to protect your income if you are unable to work due to illness or injury and is purchased as part of a group employment plan or privately through an insurance company.
Policies pay between 50-60% of your salary and benefits continue until you return to work, or for the number of years stated in the policy. If you have long-term disability insurance, you should file a claim right away. LTD coverage is good only as long as you are still employed. Do not quit your job before you file a claim and be sure to check the policy’s definition of “disabled” as each policy will state the definition of “disabled” which is in use. Be aware that some LTD companies can require claimants to apply for SSDI also, and it’s possible to receive both long-term disability insurance benefits and SSDI concurrently.
Do I need a disability attorney?
If you have hemophilia and it has prevented you from working, you may be eligible for Social Security Disability benefits.
However, applying for Social Security Disability benefits can be a long, complicated process. An experienced Social Security disability attorney can avoid delays and costly mistakes by gathering all your medical records and filing your initial application. At the request for reconsideration and hearing levels, an attorney can collect and submit relevant medical evidence, obtain doctors’ opinions, draft a brief to the ALJ, and prepare you for questioning by the judge. An attorney can also elicit helpful testimony from you and cross-examine vocational and medical experts, demonstrating your inability to work. At the Appeals Council and federal court level, a lawyer can present legal arguments to show your case was wrongfully denied. Your chances of approval are significantly increased if you have legal representation and the most you will pay is 25% of disability backpay you are owed because fees charged by disability attorneys are regulated by federal law. There are no out-of-pocket costs – if you don’t win your case, you won’t be charged anything.
There are big differences in how Social Security claims and LTD claims are processed and how “disability” is defined.
Unlike the federal government in Social Security disability cases, LTD companies are not impartial. Hiring an experienced LTD attorney who knows the laws and regulations as well as the insurance companies and their policies will help you avoid serious mistakes and possibly losing your claim. In addition to filing your claim in a timely manner, an LTD attorney can negotiate a settlement or file an appeal for you. Most LTD attorneys handle cases on a contingency basis and charge approximately 25%-40% of a claimant’s past due benefits.
At The Texas Disability law firm Bemis Roach & Reed, our attorneys are committed to helping injured or disabled clients receive the benefits they deserve. Mr. Roach is AV Preeminent and SuperLawyers rated and has become a recognized leader in the field of Long Term Disability law. Mr Bemis focuses his practice on Social Security disability while Mr Reed handles both LTD and SSDI claims. Both are AV Preeminent and SuperLawyers rated and all our attorneys have been successfully helping people fight for their rights against big insurance companies and the government since 1993. If you have applied for benefits and been denied call 512-454-4000 for a free consultation and get help NOW.
Author: Attorney Lonnie Roach has been practicing law for over 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion rated by Martindale Hubbell. Through his extensive litigation Mr. Roach obtained board certifications from the Texas Board of Legal Specialization. Lonnie is admitted to practice in the United States District Court - all Texas Districts and the U.S. Court of Appeals, Fifth Circuit. Highly experienced in Long Term Disability denials and appeals governed by the “ERISA” Mr. Roach is a member of the Texas Trial Lawyers Association, Austin Bar Association, and is a past the director of the Capital Area Trial Lawyers Association (Director 1999-2005) Mr. Roach and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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