Does Muscular Dystrophy Qualify for SS Disability Benefits?
Can I get disability benefits if I am suffering from the effects of Muscular dystrophy (MD)?
Author: Attorney Greg Reed
Muscular dystrophy (MD) is a group of diseases that cause progressive muscle weakness and a loss of muscle mass. Because the condition is relatively rare and different forms of the disease affect different age groups, there is little data on how many Americans are affected. Muscular dystrophy usually begins in childhood and mostly affects boys, but the disease can strike people of all ages and races and both sexes. Individuals with a family history of muscular dystrophy are at a greater risk of developing the disease. If you are suffering from the effects of Muscular dystrophy (MD) you may qualify for disability benefits.
What is muscular dystrophy?
Muscular dystrophy occurs when genes that make proteins to protect muscle fibers are defective; each type of MD is caused by a gene mutation specific to that form of MD.
The main symptom of muscular dystrophy is a progressive weakening of the muscles, usually in the upper arms and legs. Gradually the muscles of other parts of the body are affected such as the throat, spine, diaphragm, heart and chest muscles. As the disease progresses, complications can develop such as trouble walking, using the arms, shortening of muscles and tendons around joints, difficulty swallowing, and scoliosis (curvature of the spine). The disease can also affect the heart muscles and diaphragm resulting in cardiac and respiratory problems.
Signs and symptoms include:
- frequent falls
- difficulty getting up after sitting or lying down
- trouble running or jumping
- muscle pain and stiffness
- walking on toes
- large calf muscles
- waddling gait
- learning disabilities
Of the many types of muscular dystrophy, the most common are Duchene Muscular Dystrophy (DMD) and Becker Muscular Dystrophy (BMD).
Duchene Muscular Dystrophy affects mostly boys aged 2 through 6, though girls can be carriers. Symptoms include general muscle wasting, but eventually all voluntary muscles are affected. Survival is rare beyond the 20s. Becker Muscular Dystrophy usually begins in early teens, but may occur in the mid-20s or later. Symptoms are similar to that of DMD, but they are milder and progression is slower
If you are suffering from Muscular dystrophy (MD) 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!
Other types of Muscular Dystrophy include:
This type affects boys and girls and is present at birth or before age 2. Symptoms include general muscle weakness and possible joint deformities. While some forms progress slowly, causing only mild disability, others progress rapidly and cause severe impairment.
This type of MD affects the shoulder and pelvic areas of the body first and occurs in late childhood to middle age. People with this type of muscular dystrophy might have difficulty lifting the front part of the foot and so might trip frequently. Onset usually begins in childhood or the teenage years.
Affects people 20-40 years of age and progresses slowly. This type is characterized by an inability to relax muscles following contractions, with facial and neck muscles usually the first to be affected. Progression is slow, sometimes spanning 50-60 years.
Usually begins in teenage years, but may occur as late as age 50. Muscle weakness usually begins in the face, hip and shoulders. The shoulder blades might stick out like wings when arms are raised.
Occurs in people 40 – 60 years of age and rarely leads to incapacity. The muscles of the hands, forearms and lower legs are affected.
There is no cure currently for muscular dystrophy, but trials for new therapies are ongoing. Treatment focuses on five main practices:
- Physiotherapy to improve flexibility and mobility;
- Physical therapy and occupational therapy to improve strength, flexibility and mobility;
- Medications to treat symptoms as well as to slow muscle wasting and increase muscle strength;
- Mobility assistance, such as electric wheelchairs, braces, and walking aids; and
- Counseling and emotional support.
Can I qualify for Social Security Disability Income if I have muscular dystrophy?
Muscular dystrophy can be a severely disabling condition; in time, most people with MD are confined to a wheelchair.
The Social Security Administration recognizes muscular dystrophy as an impairment in its Blue Book under Section 11.13 and individuals whose symptoms match the criteria of this listing can automatically qualify for Social Security Disability benefits. To be approved for SSDI, your symptoms must meet one set of the following requirements:
- Disorganization of motor function in two extremities. This means you have extreme difficulty using two arms or legs and are severely limited in your ability to stand up from a seated position, balance while standing or walking, or use your upper extremities. Typically, an individual with MD would have trouble using their arms to stand, walk, lift items, reach, type or perform daily tasks like getting dressed, cooking, cleaning and shopping.
- Marked limitation (more than moderate) in physical functioning and in one of the following:
- Understanding, remembering, or applying information;
- Interacting with others;
- Concentrating, persisting, finishing tasks at a reasonable speed; or
- Adapting or managing oneself (taking care of oneself, handling emotions, adapting to changes).
You should be prepared to submit complete medical records to Social Security as evidence of your disability.
The more information you provide at the beginning of the application process, the more quickly you will be approved. In addition to a confirmed diagnosis, your records should include:
- physician notes and reports
- muscle biopsies
- nerve conduction studies
- DNA or blood enzyme tests
- results from MRIs, CT scans and x-rays
- medications you take and any side-effects you experience
- physical therapy and occupational therapy records
What if my disability doesn’t meet the requirements of Social Security’s listing?
If your symptoms don’t meet Social Security’s listing requirements for muscular dystrophy, you may still be eligible for disability benefits if you can show that your medical condition has reduced your functional capacity to such an extent that you can no longer work at your job or any job.
MD can cause weakness in the back and shoulders making it difficult to lift or carry objects as well as respiratory problems which would exclude working in extreme temperatures or dusty environments.
Social Security will review your medical records and doctor’s opinion and conduct a residual functional capacity (RFC) assessment to evaluate your ability to perform work-related tasks in view of your symptoms and limitations.
You should also ask your doctor to fill out an RFC form, giving a detailed opinion as to your abilities and limitations based on objective evidence in your medical records. Especially important are limitations in your ability to walk, lift, push, pull, bend, grasp, and work with other people. Social Security will also take into account whether you are able to drive, your age, and level of education. The lower your RFC score, the more likely you will be approved for benefits.
Social Security may determine 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.
What are the basic financial requirements for SSDI?
Even if you meet all the criteria for multiple sclerosis, you won’t be approved for SSDI unless you satisfy Social Security’s basic financial requirements.
In addition to having a disability that has lasted, or is expected to last, 12 months, 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. Also, 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 if your initial application is denied; most initial applications are and you will have an opportunity to appeal. There are four steps to Social Security’s 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 need-based 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. 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. LTD coverage is good only as long as you are still employed. Also, note 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 muscular dystrophy and you are unable to work, you may be eligible for Social Security Disability benefits.
However, applying for Social Security Disability benefits can be a long, complicated process and can be extremely frustrating, especially for a person with a disability. An experienced Social Security disability attorney can gather all necessary medical records and file your initial application, avoiding delays and costly mistakes. 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 a 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. If your application is denied, your chances of approval are significantly increased if you have legal representation. 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.
Social Security claims and LTD claims are processed differently.
LTD companies are not impartial and each policy has its own definition of “disability.” Hiring an experienced LTD attorney who has thorough knowledge of the laws and regulations as well as the insurance companies and their policies will help you avoid serious mistakes and potentially losing your claim. In addition to filing your claim, 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 Greg Reed has been practicing law for 29 years. He is Superlawyers rated by Thomson Reuters and is Top AV Preeminent® and Client Champion Gold rated by Martindale Hubbell. Through his extensive litigation Mr. Reed obtained board certification from the Texas Board of Legal Specialization. Greg is admitted to practice in the United States District Court - all Texas Districts and the United States Court of Appeals-Fifth Circuit. Mr. Reed is a member of the Travis County Bar Association, Texas Trial Lawyers Association, past Director of the Capital Area Trial Lawyers Association, and an Associate member of the American Board of Trial Advocates. Mr. Reed and all the members of Bemis, Roach & Reed have been active participants in the Travis County Lawyer referral service.
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