Covid-19 and SSA Disability Benefits

[generalsherman]

Put out an SSR, “we evaluate COVID-19 based on the listings for the affected body system,” bing bang bong.

[shoocat]

perhaps as an immune condition or a respiratory listing?

[hopefalj]

Feb 23, 2021 17:09:10 GMT -5 shoocat said:

perhaps as an immune condition or a respiratory listing?

I think you can probably already consider it under 14.07 as an acquired immune deficiency disorder. The issue with long-haulers is probably going to be duration. Certainly some unfortunately experience debilitating symptoms 12 months, but some “only” experience them for 3-6 months before recovering back to some normalcy. As always, it’s going to be case by case, but by the time an application gets to us, we should have sufficient documentation of a 12-month window.

[lurkerbelow]

I know this probably isn't a popular answer, but my understanding of SSA law is that the limitations must be caused by a medically determinable impairment:

§ 404.1521. Establishing that you have a medically determinable impairment(s).



If you are not doing substantial gainful activity, we will then determine whether you have a medically determinable physical or mental impairment(s) (see § 404.1520(a)(4)(ii)). Your impairment(s) must result from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. Therefore, a physical or mental impairment must be established by objective medical evidence from an acceptable medical source. We will not use your statement of symptoms, a diagnosis, or a medical opinion to establish the existence of an impairment(s). After we establish that you have a medically determinable impairment(s), then we determine whether your impairment(s) is severe.

[82 FR 5868, Jan. 18, 2017].  Given this standard, I do not believe that the long-haulers can meet this definition until a better understanding of what the post-viral period is reached. 

SSA Disability is not typically at the cutting edge of the medical field...

[hopefalj]

Feb 23, 2021 21:04:31 GMT -5 lurkerbelow said:

I know this probably isn't a popular answer, but my understanding of SSA law is that the limitations must be caused by a medically determinable impairment:

§ 404.1521. Establishing that you have a medically determinable impairment(s).



If you are not doing substantial gainful activity, we will then determine whether you have a medically determinable physical or mental impairment(s) (see § 404.1520(a)(4)(ii)). Your impairment(s) must result from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques. Therefore, a physical or mental impairment must be established by objective medical evidence from an acceptable medical source. We will not use your statement of symptoms, a diagnosis, or a medical opinion to establish the existence of an impairment(s). After we establish that you have a medically determinable impairment(s), then we determine whether your impairment(s) is severe.

[82 FR 5868, Jan. 18, 2017].  Given this standard, I do not believe that the long-haulers can meet this definition until a better understanding of what the post-viral period is reached. 

SSA Disability is not typically at the cutting edge of the medical field...

I don’t think that’s an issue. It isn’t difficult to establish a Covid diagnosis with appropriate lab/clinical testing. Then the question becomes whether Covid could cause long-hauler symptoms.

Looking at 404.1529, “ There must be objective medical evidence from an acceptable medical source that shows you have a medical impairment(s) which could reasonably be expected to produce the pain or other symptoms alleged and that, when considered with all of the other evidence (including statements about the intensity and persistence of your pain or other symptoms which may reasonably be accepted as consistent with the medical signs and laboratory findings), would lead to a conclusion that you are disabled.”

So if Covid can be expected to cause long-hauler symptoms in some people (which I seems to be the case for some people unfortunately), it is possible to evaluate the condition so long as the residual symptoms last at least 12 months in duration. It’s not a lot different than other conditions that can have long-term residual effects, like strokes, heart attacks, etc. Nobody has a stroke or heart attack for 12 straight months, but it doesn’t mean the MDI can’t continue to affect them for 12 months.

[lurkerbelow]

Let me pose two hypotheticals that I hope clarify my concern.

Patient A and Patient B both have COVID long-hauler syndrome that is documented in the records. Records show one STEMI encounter two years afterwards, but the claimant is released the same day. Claimant subsequently recovers and is treated with baby aspirin. Patient A files for disability based on the fact that he is more likely to have a heart attack and other issues.

During treatment for COVID, Patient B developed thrombocytopenia, which is managed medically. Claimant files for disability based on future events. He has had three documented hypertensive episodes that did not require medical intervention.

These are not based on any real world example. Would these be accepted or denied? I have no idea. But they are a problem.

[foghorn]

Unless either can show that hey will be (or have been) unable to engage in s.g.a. for one year,  which isn't present in either example, then I don't see them getting the benefits.

Perhaps the issue you are thinking about is whether "medically determinable impairment " requires an acceptance of the underlying etiology--similar to r.s.d. in the early days, or c.f.s.--or pretty much any syndrome.

The likely problem is less that, as most long haulers had pretty significant symptomology, but a problem in  having the aftercare records showing the symptom's  link to the Covid illness. With the medical system under stress, once patients are released there ism by and large little follow up. For that matter patients may be leery about returning. If so  there will be little medical documentation, and when it does show up it may lack the tests for the "objective clinical " signs of disease symptomology, nor any functional capacity evaluation.

As with any case, much will depend on the medical practitioner the person sees. If they are willing to spell out the underlying basis for the diagnosis, great. If they just give conclusory statementsm unless the state determination unit works up the case, chances are the applicant will be DENIED. 

That is as things are presently. If Covid medical benefits or provider reimbursement is there, I'd expect to see institutional chians open Long Hauler Clinics which would generate the reports keyed to SSD requirements.

[jimmy224]

You might have some folks that meet a listing due to Covid. For example, listing 11.2 for coma indicates a person meets that listing if they are in a coma for at least a month. So if a person had covid and was in a coma for at least a month, they would meet listing 11.2. I am not sure how long they would continue to meet that listing, though (maybe until no longer in a coma🤔). So maybe you could have a disability only lasting a month?

[lurkerbelow]

Feb 28, 2021 18:57:09 GMT -5 jimmy224 said:

So maybe you could have a disability only lasting a month?

Pretty sure that's off the table given SSA's definition of disability lasting twelve consecutive months.  And hey, I appreciate the responses.  It's great to learn new viewpoints on these issues.

[aa7]

Feb 28, 2021 18:57:09 GMT -5 jimmy224 said:

You might have some folks that meet a listing due to Covid. For example, listing 11.2 for coma indicates a person meets that listing if they are in a coma for at least a month. So if a person had covid and was in a coma for at least a month, they would meet listing 11.2. I am not sure how long they would continue to meet that listing, though (maybe until no longer in a coma🤔). So maybe you could have a disability only lasting a month?

Listing 11.2 does not cover medically induced coma

[aa7]

Feb 28, 2021 14:04:49 GMT -5 lurkerbelow said:

Let me pose two hypotheticals that I hope clarify my concern.

Patient A and Patient B both have COVID long-hauler syndrome that is documented in the records. Records show one STEMI encounter two years afterwards, but the claimant is released the same day. Claimant subsequently recovers and is treated with baby aspirin. Patient A files for disability based on the fact that he is more likely to have a heart attack and other issues.

During treatment for COVID, Patient B developed thrombocytopenia, which is managed medically. Claimant files for disability based on future events. He has had three documented hypertensive episodes that did not require medical intervention.

These are not based on any real world example. Would these be accepted or denied? I have no idea. But they are a problem.

What are the ongoing functional restrictions that more than minimally impact the claimant's ability to perform work related activities in either example? I dont see any.  

[nappyloxs]

Feb 23, 2021 20:19:08 GMT -5 hopefalj said:

Feb 23, 2021 17:09:10 GMT -5 shoocat said:

perhaps as an immune condition or a respiratory listing?

I think you can probably already consider it under 14.07 as an acquired immune deficiency disorder. The issue with long-haulers is probably going to be duration. Certainly some unfortunately experience debilitating symptoms 12 months, but some “only” experience them for 3-6 months before recovering back to some normalcy. As always, it’s going to be case by case, but by the time an application gets to us, we should have sufficient documentation of a 12-month window.

This seems about right. I wrote out the nmdi, non-durational language for it, but decided not to post it. Problem is sxs may wax and wane and there is no diagnostic criteria yet for long hauler, I believe. Beside 14.07, SSR 14-1p CFS also seems appropriate to use.

Remands on these cases will be interesting.