Scleroderma and Social Security: What You Need to Know to Get Benefits

Welcome to Season 2, Episode 20 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into Scleroderma and Social Security: What You Need to Know to Get Benefits.

For people living with scleroderma, the impact of the disease can be profound. Pain, fatigue, organ involvement, digestive complications, and mobility limitations can make it difficult to maintain employment and carry out everyday activities. Yet when it comes to Social Security Disability benefits, a diagnosis alone is rarely enough to secure approval. In this episode of Winning Isn’t Easy, we examine how Social Security evaluates disability claims involving scleroderma and why proving disability is often more challenging than many claimants expect. We discuss the wide range of symptoms associated with the disease, how the variability of those symptoms can affect a claim, and why judges often focus on a claimant’s ability to function despite periods of relative improvement. We also explore the medical evidence needed to support a claim, the complications that may strengthen a case, and the critical role residual functional capacity (RFC) plays in determining whether benefits are awarded. If you are considering filing for disability benefits due to scleroderma, this episode offers a clearer understanding of how these claims are evaluated and what evidence can make the difference between approval and denial.

In this episode, we'll cover the following topics:

One - Do I Qualify for Social Security Disability Benefits If I Have Scleroderma?

Two - When Your Scleroderma Makes It Impossible to Work

Three - Systemic Scleroderma and Your Rights to Social Security Disability

Whether you're a claimant, or simply seeking valuable insights into the disability claims landscape, this episode provides essential guidance to help you succeed in your journey. Don't miss it.


Listen to Our Sister Podcast:

We have a sister podcast - Winning Isn't Easy: Long-Term Disability ERISA Claims. Give it a listen: https://wiedisabilitypodcast.buzzsprout.com


Resources Mentioned In This Episode:

LINK TO YOUR RIGHTS TO SOCIAL SECURITY DISABILITY: https://mailchi.mp/caveylaw/your-rights-to-social-security-disability-benefits

FREE CONSULT LINK: https://caveylaw.com/contact-us/


Need Help Today?:

Need help with your Social Security Disability claim? Have questions? Please feel welcome to reach out to use for a FREE consultation. Just mention you listened to our podcast.

Review, like, and give us a thumbs up wherever you are listening to Winning Isn't Easy. We love to see your feedback about our podcast, and it helps us grow and improve.

Please remember that the content shared is for informational purposes only, and should not replace personalized legal advice or guidance from qualified professionals.

Transcript

Nancy Cavey [00:00:00 - 00:00:43]

Foreign. Do you think having scleroderma automatically qualifies you for your Social Security disability benefits? I want you to think again. Now, I know this autoimmune disorder can be serious, but the path to approval is rarely straightforward. Welcome back to Winning Isn't Social Security Disability Benefits. This is the podcast where we break down everything you need to know about navigating the Social Security disability system. And I'm your host, Nancy Cavey. Before I get started, I have to give you that legal disclaimer. This podcast is not legal advice.

Nancy Cavey [00:00:44 - 00:01:34]

The Florida Bar association says I have to say this. And now that I've said it, nothing will prevent me from giving you an easy to understand overview of the Social Security disability claims process, the games that are played, and what you need to know to get the benefits you deserve. So off we go. Now, I know and you know that scleroderma, it can be a progressive autoimmune disorder affecting the skin, organs, connective tissue. But proving your Social Security disability claim can be often much more complicated than just the diagnosis. I think that one of the biggest challenges of scleroderma disability claims is the variability of the disease itself. Now, the symptoms can include skin thickening, joint pain, digestive issues, lung and kidney complications, and fatigue. The severity, however, and the combination will differ from person to person.

Nancy Cavey [00:01:34 - 00:03:08]

And that unpredictability can make it difficult for Social Security to assess whether your condition truly prevents you from working. And sometimes I will tell you that Social Security will will take a one size fits all approach and not really look at your symptoms individually. And the question, of course, is whether or not you can continue to do the lightest job you held in the five years before you became disabled, or whether you can do other work in the mythical hypothetical, not real world national economy. In view of your age, education, skills and restrictions. In looking at a scleroderma case, the Social Security judges are going to look at whether you are capable of working despite your symptoms. So let's say you are attempting to work, you have difficulties, but you're still managing your earning under sga? The question may be in the judge's mind, well, if you can work, why can't you work full time? Why are you having difficulty working when your symptoms appear to be mild? And that kind of misconception, or misanalysis, if you will, of these types of cases can lead to a denial. So in this episode, I want to talk about how scleroderma is evaluated by Social Security, what symptoms and complications are important to document, and how a residual functional capacity form can ultimately ultimately determine whether your claim is approved or denied. So I'm going to talk about three things today.

Nancy Cavey [00:03:09 - 00:03:35]

1. Do I qualify for Social Security disability if I have scleroderma? 2. When does your scleroderma make it impossible to work and you should file a claim for benefits? And three systemic scleroderma and your rights to Social Security disability benefits. Before we get started, let's take a break and come back with a pen and a pencil because we have some great insights for you that we will make the difference in helping you get your Social Security disability benefits.

Speaker B [00:03:36 - 00:03:57]

Are you considering filing for Social Security disability or has your claim been denied already? Either way, you require a copy of your rights to Social Security disability benefits, which will cover everything you need to know about the Social Security disability claims process. Request your free copy of the book@kvlaw.com today.

Nancy Cavey [00:04:01 - 00:05:02]

Welcome back to Winning Isn't Easy. Do I qualify for Social Security disability benefits if I have scleroderma? I will tell you the Social Security Administration doesn't make it easy for those who have scleroderma to get Social Security benefits. Many claims are denied because Social Security will say, hey, your medical condition does not meet the requirements or elements of a medical listing at step three. I will tell you that 90% of the time people don't meet a listing at step three. And and it's not because they don't have a severe problem. It's because doctors didn't take a class in medical school to learn how to write a report to document the elements of a listing. Most of these cases are going to end up at step four and five. And at step four the issue is can you go back to the lightest and simplest job you held in the five years before this claim was decided? And at step five, is there other work in the mythical hypothetical, not real world national economy you wouldn't want to do doesn't pay a living wage in view of your age, education, skills and your residual functional capacity.

Nancy Cavey [00:05:02 - 00:06:12]

So let's set the framework for this discussion. What is scleroderma? Well, it's a hardening of the skin caused by the connective tissue and it's used the same, if you will, with different types of scleroderma and sclerosis. The its progressive systemic sclerosis, pss, which affects both the skin and the organ systems such as the heart, lungs, kidneys and gastrointestinal system. I try to distinguish in my cases between I'm going to call it basic scleroderma and progressive systemic sclerosis PSS because I think because they present differently medically, they also have to be presented differently legally. And that's particularly true because the severity of your symptoms can vary and those symptoms presentations will differ from person to person. So I don't want Social Security to use this cookie cutter. One cut is the same as everybody else, if you will. One cookie is the same as the other cookie.

Nancy Cavey [00:06:13 - 00:07:10]

So let's start out first with the scleroderma and the medical listing that I mentioned. And at step three, Social Security is going to ask whether you meet a listing. And if you do, your benefits are awarded based on the severity of your medical impairments. Now, scleroderma is a listed medical condition. You have to have a diagnosis of scleroderma and meet one of the following four conditions and your medical records have to document this. You saying you have it isn't going to cut it. So one of the following four conditions. Multiple body systems affected with two of the following symptoms, fever, malaise, severe fatigue, involuntary weight loss, contractures or atrophy of the toes that will prevent you from walking without assistive devices, finger contractures or deformities in both of your hands, not one, both of your hands that prevent you from performing fine motion like picking up a coin or buttoning a button or.

Nancy Cavey [00:07:10 - 00:08:05]

Or gross movements. Irreversible atrophy in one or both of your legs that prevent you from walking without assistive devices or irreversible atrophy in both arms that prevent you from performing both those spine and gross motor movements or Reynolds phenomena with one of the following gangrene in at least two limbs. Ischemia with open sores on the toes that prevent you from walking. I'm sorry, walking without assistive devices and. And ischemia with open sores on your hands that prevent you from doing these fine and gross motor movements. Recurrent symptoms of systemic scleroderma that can cause significant interference with day to day activities, social functioning, or your ability to finish tasks in a reasonable time, along with two of the following symptoms. Fever, malaise, severe fatigue and involuntary weight loss. Now, if you manage to put yourself in one of those four categories, benefits are going to be automatically awarded.

Nancy Cavey [00:08:06 - 00:09:04]

And there is also potentially a situation where you might be fast tracked for claims determination under what's called the Compassion Allowance Program. And the Compassion Allowance Program is sort of like the Fast Pass of Disney, if you will. It's not that your benefits are going to be awarded, you just get put ahead of everybody else. But Social Security is going to use this analysis. The do you mean a listing at step three, can you do your past work or can you do other work? Now, what's key here is that your medical records have to establish every element of a medical listing. And I will tell you that unfortunately, even in the best of cases, I don't see the medical records documenting the elements of the listing. And that's because doctors didn't take a class in medical school to learn how to write the documentation. Or alternatively, you don't at this point in your disease have those elements.

Nancy Cavey [00:09:04 - 00:09:50]

So all is not lost because we'll move on to steps four and five of the five step sequential evaluation. And I'm going to talk about that in greater detail in our next segment. So let's take a break. Foreign. Welcome back to Winning Isn't Easy. Let's talk about when your scleroderma makes it impossible to work. If you don't meet a listing. And as I've said, many people don't meet a listing, you're going to have to prove at step four that you can't return to the lightest job you held in the five years before your claim is decided.

Nancy Cavey [00:09:50 - 00:10:50]

And the abbreviation we Social Security lawyers use is prw Past relevant work. Most cases, however, decided at step five. And this is what I call a cockamamie, not real world test. And the test is, is there other work in the mythical hypothetical, not real world national economy based on your age, education, skills and your residual functional capacity? Now, if you're over 50, there's other way at step five to win, and that's something called the grids. I'm not going to talk about that in this segment. What happens at step five is that the Social Security Administration or ultimately a judge is going to try to determine what's called your residual fall functional capacity. It's what you can do despite your scleroderma and any other medical conditions caused by the scleroderma. And so we want to document the underlying functional limitations, be they physically, physical, cognitive or psychiatric, of the scleroderma, but also any complicating medical conditions.

Nancy Cavey [00:10:51 - 00:11:51]

So Social Security is going to review your medical records at the initial application and reconsideration stage and and try to determine whether you can do heavy work, medium work, light work, sedentary work, and if necessary, send you out for a consultative medical exam to determine your restrictions. Now I find that Social Security consultants, doctors will often opine that you can do lighter sedentary work and that generally is going to result in a claims denial. The lower your residual functional capacity, the more likely it is. You can't go back to the lightest and simplest job you held in the five years rather before you became disabled. I think it is crucial that you use forms called residual functional capacity forms. Now, Social Security isn't going to tell you about these forms. We Social Security lawyers use them. So a scleroderma RFC form is going to talk about how far you can walk, how long you can sit and stand at one time and during an eight hour day, how much you and often you can lift, stoop, squat or bend.

Nancy Cavey [00:11:52 - 00:13:21]

Whether you can alternate sitting and standing. Whether you have problems with your hands that impact your ability to engage in fine and gross motor movement. Whether you have trouble with your lower extremities that make it difficult for you to walk and require the use of assistive devices, whether you've got good days and bad days and how many days a month would you miss time from work, your ability to complete tasks in a timely manner, whether you have any psychological problems. Now, there isn't an RFC form specifically for scleroderma, so I use an arthritis residual functional capacity form and that's sometimes the closest we can get. But I will also add generally a psychological residual functional capacity form. Now, if my client has other medical conditions other than the scleroderma, I'm going to add or ask my clients to get those other RFC forms to their doctors. So it might be that my client has scleroderma, but superimposed on that, they also have fibromyalgia or let's say they have gastroenterological side effects from the scleroderma. I'm going to ask that the doctor fill out not only this arthritis form RFC form, but also fill out a gastroenterological residual functional capacity form.

Nancy Cavey [00:13:21 - 00:14:28]

I want to really develop all the medical conditions and symptoms, if you will, of the scleroderma and quantify the person's functional restrictions and limitations, be it physical, cognitive or psychiatric. Now why is that important? Well, Social Security is going to determine your functionality based on the dot strength level criteria of heavy work, medium work, light work, sedentary work, or less than sedentary. So they're going to try to determine what your strength functionality is and then they're going to look at your work history and look at the strength level of the lightest job you held in the five years before you became disabled and they're going to try to match them up. So let me give you an example. Let's say you've stopped work because of scleroderma and its complications and you are now only able to work in a light functional capacity. But your past work was a mechanic, which was heavy. Clearly you couldn't go back to work as a mechanic and you would meet step four. Now, that doesn't mean necessarily your case is one, because we're going to go on to step five, that crazy cockamamie, not real world test.

Nancy Cavey [00:14:28 - 00:15:18]

And I'm not talking about the grid test here yet. But the ultimate factor is whether you can do other work in the national economy in view of your age, education, skills and your level of functioning. So let's say you have problems because of the scleroderma with your hands and you're going to be unable to do fine motor or gross motor movements. Maybe you can only do them occasionally. You're going to miss 20%. I'm sorry, you're going to be off task at least 20% of the time because of the combination of all your symptoms of the scleroderma and any complications. And you're going to miss work at least two days of work per month. You probably are going to be able to meet step five because you can't do the sedentary type jobs that Social Security or vocational evaluators will say that require bilateral manual dexterity.

Nancy Cavey [00:15:18 - 00:16:15]

Now, obviously each case is unique because you experience your symptoms differently and and your medical records and RFC forms should address those issues. Now, if you're over 50, we also want to use something called the grids and ultimately they'll determine whether you grid out because the skills that you have learned and your age would impact your ability to do other work. In any event, I think that the RFC forms and your medical records are really the key to winning your benefits. So make sure you are explaining the symptoms of your scleroderma. What's the location, intensity, duration and frequency? If you're having multiple system involvement, you want to do the same thing. Location of the symptoms, what are the symptoms, the duration, frequency. Give me an example, if you will, of the problems that you have functionally. And if you've got other complications or other diseases, you want to do the same thing.

Nancy Cavey [00:16:16 - 00:16:31]

Your medical records need to tell the story of your symptoms, how they impact your functionality. With an example of your functionality, in my view, the medical records and the RFC are key to getting your benefits. Let's take a break.

Speaker B [00:16:33 - 00:17:00]

Struggling with your Social Security disability case? The right attorney can make all the difference. Get our booklet the key to hiring a great attorney for your Social Security disability case. Discover how to find an experienced attorney who will fight for your rights and Navigate the process with ease. Don't leave your future to chance. Request your free copy@kvlaw.com today and ensure you have the expert support you deserve.

Nancy Cavey [00:17:03 - 00:18:08]

Welcome back to Winning Isn't Easy. Systemic scleroderma and your rights to Social Security disability benefits Systemic scleroderma SS is an autoimmune disorder that can entitle you to your Social Security benefits. In fact, over 300,000 cases are diagnosed every year. Now, what happens is your immune system is attacking your body because it believes you have an infection or a foreign substance, when in fact, you don't. It's a form of a connective tissue disorder that affects the connective tissue throughout your body. And that's important because I don't think Social Security understands the impact of connective tissue disorders. Now, SS can often affect your skin, blood vessels, muscles, your heart, digestive system, lungs, and your kidneys, and it can also cause complications involving other organs. The symptoms and the severity are going to vary from person to person depending on what what body systems are involved and what organs are involved.

Nancy Cavey [00:18:08 - 00:19:13]

And I think that Social Security's lack of understanding and your lack of proper presentation can result in a claims denial. What are the symptoms that can be disabling and should be documented in your medical records? Well, in the early stages of ss, the skin may think and you might have shiny areas on your mouth develop around your nose, your fingers, and your bony areas. Now, sometimes Social Security will deny an SS claim early in the process because they don't think the skin changes are disabling, and that's because they don't understand them. Your medical records have to explain these symptoms and how they impact their ability to work as the disease progresses. It's also important that your medical records are documenting the symptoms, including calcium deposits under the skin. And sometimes I'll have my clients actually take pictures so that we can submit them to the Social Security administration. You might have shortness of breath. You might have diarrhea or constipation, difficulty swallowing, and renounced symptoms.

Nancy Cavey [00:19:13 - 00:20:05]

What I want and what you should be doing is making a point of explaining to your doctors each one of these symptoms and how those symptoms impact their ability to function. So you, for example, might have an array of symptoms. But let's just talk about your joint symptoms. And in particular, you might have multiple joint involvement and you want to address each one of the joints. So let's say you have joint pain and stiffness in your hands. Well, that's important because if you have difficulties manipulating things, have difficulty with bilateral manual dexterity it's probably going to be hard for you to do your past work or other work. And so this stiffness might make it difficult for you to button a button like on my shirt or pick up coins. And you might also have problems with gross motor movements with your hands.

Nancy Cavey [00:20:05 - 00:20:56]

As a result, you might have difficulty picking up even a coffee cup and drop it. Or if you pick up a gallon of milk, you're picking it up with one hand, but cradling it with the other hand against your body. That type of information is really important for, for the judge and Social Security. So you should be documenting the symptoms. What are they? Where are they located? Give examples of the duration, intensity, frequency, and also talk about the practical problems you have. Now, I know that there are complications of systemic scleroderma because it can affect multiple organs in your body. And again, I think you need to take an organ by organ approach and address the complications. So let's say you have heart failure.

Nancy Cavey [00:20:56 - 00:22:01]

You want to talk about the common symptoms that you're having. And that can include palpitations, racing of the heart, shortness of breath with exertion, shortness of breath without exertion, fatigue. You might have swelling in your lower extremities, so you have to elevate your legs. Does any of that sound familiar? Well, each one of those symptoms is important to develop in terms of the location, the nature of those symptoms, the duration of the symptoms, the frequency of the symptoms, and a practical example. So because of the shortness of breath, you may not be able to walk on island publix because of the swelling in your legs. Because of the heart condition, you may have to elevate your legs two or three times a day because of the swelling, and it may be 20 minutes at a time, or because of the heart medication you're taking. You may have to use the restroom once an hour, and you're in the restroom for five or 10 minutes. Those are the kinds of details that can make or break your case.

Nancy Cavey [00:22:01 - 00:23:10]

You might have kidney changes that lead to high blood pressure. So you want to list all of those kidney changes you're having, the problems, the symptoms that you're having, location, duration, intensity, frequency. With an example, I know that I'm pounding this, but I'm pounding it because we want to argue that the underlying disease is disabling in and of itself. But then we want to argue that if you have complications, either each one of those complications individually are disabling, or the whole combination of your presentation entitles you to your Social Security disability benefits. I want to switch topics slightly here. Systemic scleroderma can occur with other medical conditions, other autoimmune disorders, and it's common for scleroderma to also occur in medical conditions like lupus. And this is called a mixed connective tissue disorder. In this case, I want Social Security to consider the underlying scleroderma and I want them to consider lupus.

Nancy Cavey [00:23:11 - 00:24:37]

I want them to do that individually, both conditions, and then in combination. So again, it's really crucial. How you experience scleroderma and other medical conditions are unique to you, and you need to explain that to your physician to make sure that your medical records are documenting your symptoms and functionality. But you know, I'm a big believer in residual functional capacity forms and I want a properly completed residual functional capacity form to be prepared. So we want potentially a scleroderma RFC form or another type of immunological form form completed that will document your functional restrictions. But if you've got a heart condition, I also want heart condition form. If you are having your scleroderma in conjunction with lupus, I also want a lupus residual functional capacity form. I think the key to getting your benefits is this documentation that well developed medical records that tells the story not only of the medical diagnosis, but your restrictions and limitations, your symptoms and your functionality, and that those restrictions and limitations are documented in a well completed residual functional capacity form by your doctor.

Nancy Cavey [00:24:37 - 00:25:07]

That's the story, the story of your symptoms and functionality. In my opinion, that will allow you to win your Social Security disability claim. So that's it for this week's episode of Winning Isn't Easy. If you found this episode helpful, take a moment to like our page, leave a review, and recommend it to your family or friends. And better yet, subscribe to this podcast. Please join us next week for another insightful episode of Winning Isn't Easy. Thanks for listening.