Sleep Apnea and Social Security Disability: Why Claims Fail

Welcome to Season 2, Episode 22 of Winning Isn't Easy: Navigating Your Social Security Disability Claim. In this episode, we'll dive into Sleep Apnea and Social Security Disability: Why Claims Fail.

Sleep apnea and other sleep disorders can have a profound impact on a person's ability to function, affecting concentration, memory, energy levels, and overall work performance. Despite these challenges, Social Security Disability claims based on sleep disorders are often difficult to prove and frequently result in denials. In this episode of Winning Isn’t Easy, we examine why disability claims involving sleep apnea, insomnia, narcolepsy, and related sleep disorders face unique obstacles within the Social Security Disability system. We discuss how Social Security evaluates these claims, the medical and functional evidence needed to establish disability, and why a diagnosis alone is rarely enough to secure benefits. We also explore the reasons many claims are denied, the importance of documenting the real-world effects of sleep-related impairments, and the steps claimants can take to strengthen their cases. If you are considering filing for Social Security Disability benefits because of a sleep disorder, or if your claim has already been denied, this episode provides valuable insight into the challenges these claims present and what it takes to pursue a successful outcome.

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

One - Why Sleep Apnea Social Security Disability Claims Are Often Denied

Two - How Social Security Evaluates Sleep Disorder Disability Claims

Three - Five Ways to Strengthen and Win Your Sleep Disorder Disability Claim

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/


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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.

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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 - 00:00:53]

Foreign. Sleep apnea and other sleep disorders affect millions of Americans, but Social Security disability claims are often denied. And in this episode, I'm going to explain why it can be so difficult to win a sleep apnea or sleep disorder Social Security claim and what you can do to improve your chances. Welcome back to this episode of Winning Isn't Easy. Social Security Disability Benefits this is a podcast where we break down everything you need to know about navigating the Social Security system. I'm your host, Nancy Kaby. Before we get started, I've got to give you a legal disclaimer. This podcast isn't legal advice.

Nancy Cavey [00:00:53 - 00:01:53]

The Florida Bar association says I have to say this. 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 during that process, and what you need to know to get the disability benefits you deserve. So off we go. Now. Today I'm going to be talking about sleep apnea, insomnia and other sleep disorders and how they affect Social Security disability claims. If you've been diagnosed with sleep apnea or another sleep condition and your doctor has probably told you to stop work and apply for your Social Security disability benefits, but I don't want you to be surprised if your claim gets denied even when your doctor supports your claim. In this episode, I want to walk you through some of the important things you need to understand if you're thinking about filing a claim or if your claim has been denied or you're getting ready for a hearing in front of a Social Security judge involving a sleep apnea or sleep disorder claim. So let's get started.

Nancy Cavey [00:01:53 - 00:02:32]

I want to talk about three things. One, why is a sleep apnea Social Security disability claim often denied? Number two, how the Social Security Administration evaluates a sleep disorder disability claim and three, the five ways you can strengthen and win your sleep disorder disability claim. Now, I'm going to take a quick break, but when you come back, please bring a piece of paper, a pen or a pencil. There's a lot of important information here that I want you to write down so that you can give some very serious thoughts about how you're going to go about structuring and winning your sleep apnea sleep disorder Social Security Disability claim. Got it.

Speaker B [00:02:32 - 00:02:54]

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Nancy Cavey [00:03:08 - 00:03:43]

Welcome back to Winning isn't Easy. Why sleep apnea, sleep disorder, sulcro disability claims are often denied. You might have been told by your doctor to stop work. You've had objective testing that documents the sleep apnea and it's so severe that you're not able to function at work or at home. So you've done what your doctor told you to do. You stopped work and you applied for your benefits. And guess what? You got a denial. You're scratching your head saying what's going on? Well, let me explain to you why winning a sleep apnea claim is hard.

Nancy Cavey [00:03:43 - 00:05:05]

Number one, the Social Security administration and Social Security judges think that sleep apnea is treatable. If you just use that plastic mask and kept it on, you'd be able to return to work and you wouldn't be filing a Social Security disability claim. So it is the question of compliance with treatment. Number two, I will tell you that medical records don't often properly document the results of treatment, the trials, the multiple trials of unsuccessful attempts to use various types of masks, or the issue of titration that have been attempted, or the fact that you were recommended to undergo surgery and you did and you still have significant sleep problems. And these records don't tell the story of the impact of the lack of sleep on your functionality both at home and at work. Let me give you an example. I once represented a person whose sleep apnea was so bad that when she was able to make it to work, she had to take breaks and she would go out to her car and go finally get to sleep. But then her supervisor would have to come out to her car and knock on the window to wake her up because she was missing time, she was, you know, missing production requirements.

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

And ultimately, of course, this person got terminated. But she also had problems in her personal life. She would come home exhausted and would have difficulty sleeping, difficulty functioning at home. She was irritable with her family, her friends and her co workers. And unfortunately, the medical records did not document the problems that she was having with treatment, the fact that she was compliant, and the fact that even her own employer ultimately terminated her because of these problems. What's the third reason? Well, socially, disability applicants didn't obtain a sleep apnea residual functional capacity form. Now, your doctor may have told you to stop work and apply for benefits, but what I find is that the medical records don't address your functionality despite your sleep apnea. You probably didn't even know that there was a residual functional capacity form.

Nancy Cavey [00:05:57 - 00:06:49]

Administration won't Tell you about the forms that we Social Security lawyers have completed. Now, what's the purpose of this form? It's to document your physical and cognitive problems and limitations that prevent you from performing your past work and at step five, other work in the national economy. The fourth problem I see is that the applicant doesn't do a good job explaining on their work history form their job duties and the job duties they can't perform anymore. So I want you to think backwards. Think about all of your symptoms, write them down, then draw a line across them and talk about how often those symptoms occur, how long they last, and then think backwards here for me. You know what your symptoms are, but think about those job duties you have that you cannot do anymore because of those symptoms. Think about the job duties that you have trouble doing. Okay.

Nancy Cavey [00:06:49 - 00:08:07]

And write them all down on that work history form because it really is important that the Social Security administration understands not only what your job duties are, but why physically or cognitively or both, you have trouble performing those duties. Now, number five is the applicant didn't clearly explain on the Social Security adult function report how their symptoms impact their ability to function at work and at home. So again, thinking about why you have difficulty doing your job in the work history form, we want you to use that same approach on the adult disability function report. It's going to be asking you questions about your activities. So think about what it is in your workplace that you can't do or have difficulty doing, both physically and cognitively, and then do the same thing at home. I'm sure that your spouse and family can give you a laundry list of all the problems that you have with your symptoms and your functionality. Make sure that your forms are telling a story. I find that the inherent bias of Social Security, the lack of documentation in medical records, the lack of an adequate description of a person's job duties, and the lack of explanation and examples on the adult function form can make it extremely difficult to win a sleep apnea claim.

Nancy Cavey [00:08:07 - 00:09:30]

It really has to tell a consistent and coherent story from beginning to end. And if you can get a former employer to also fill out the forms about the problems you had, that would be great. I know a lot of employers won't do that, but maybe a fellow co employee would be able to fill out some forms that would document the problems that you're having or any accommodations that your employer made. So you can see it can be extremely difficult to win a sleep apnea Social Security disability claim. Let's next talk about how Social Security actually decides these cases. I Want to explain to you the process they use to evaluate every disability claim and what you can do in your Social Security disability claim for sleep disorder. Let's take a break. Welcome back to Winning Isn't Easy How Social Security Disability Evaluates sleep disorder disability claims.

Nancy Cavey [00:09:30 - 00:10:31]

Now, more than 60 million Americans suffer insomnia, which can cause an inability to fall asleep or stay asleep, waking up frequently, extreme fatigue, problems with focus, concentration, decreased executive functioning, headaches, depression and anxiety. But do all these symptoms qualify for Social Security benefits? The answer is maybe. Social Security uses a five step sequential evaluation test and they use it at every stage of a claim. So you have to first prove that that you have a medical condition that would keep you out of work or has kept you out of work for at least a year. Two, that you have a medical condition that's permanent called a medically determinable impairment. This is where Social Security is going to be looking for objective proof of your diagnosis and objective evidence of your functional restrictions and limitations. Now at step three, Social Security uses a big book called the Listing of Impairments. It's based on body systems and they do have listings for sleeping disorders.

Nancy Cavey [00:10:31 - 00:11:20]

The problem, however, is the doctors didn't take a class in medical school to learn how to write a report for Social Security purposes documenting each and every element of a listing. Now, you might have more than one medical condition, not unusual with people who have sleep apnea. And we do try to develop those other medical conditions. She might have a heart condition. We would try to develop the medical listing for that heart condition if we can't meet the medical listing for a sleeping disorder. Now at 4, the question is, can you go back to the lightest, physically and cognitively demanding job you held in the five years before your claim was decided? And generally, I will tell you that's pretty easy to do unless you have a sedentary job. And at step five, there are two ways to meet step five. The first is what I call the crazy cockamamie, not real world test.

Nancy Cavey [00:11:20 - 00:12:43]

And that test is, are you unable to perform other work in the mythical hypothetical, not real world national economy in view of your age, education, skills, and whatever your functional and cognitive restrictions and limitations are as a result of your sleep apnea or sleep disorders? If you're over 50, there's another way you can potentially win, and that's called the grids. But steps four and five are really predicated upon your functional limitations. And I will tell you we can win cases for sleep apnea, obstructive sleep apnea, restless leg syndrome, rem sleep behavior disorder. But it's going to come down to incredibly detailed documentation of your symptoms and your functionality, potentially a residual functional capacity form, potentially the support of your former employer or co workers, and a story that really explains why even though you're compliant with your treatment and medication and you still can't sleep, you can't get a good night's sleep and you've got physical and cognitive problems as a result of your sleep disorder. So I'm going to take a quick break and next we're going to talk about how you can strengthen your case and what you can do to improve your chances of winning. So let's take a break.

Speaker B [00:12:44 - 00:13:12]

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Nancy Cavey [00:13:20 - 00:14:19]

Foreign. Welcome back to Winning Isn't Easy. Let's talk about the five ways to strengthen and win your sleep disorder. Social Security Claim Number one Accurately complete the work history form the key to providing your or proving your disability benefits starts with your work history form and I want you to think backwards. What are the physical and cognitive duties of your past work that you can't perform or have difficulty doing? Make sure you list out those duties. Don't be afraid to use the blank last page on the work history form because we want to be accurate and complete not only about the physical job duties but the cognitive job duties. Number two have objective evidence of the diagnosis. Now, Social Security dislikes disability claims for conditions that can't be proven without objective medical testing or where the severity can't be objectively measured.

Nancy Cavey [00:14:19 - 00:15:52]

And sleep disorders have different causes and there's different testing that can be required to make the diagnosis and then formulate a treatment plan. So what Social Security wants to see is that you've undergone testing and treatment such as overnight sleep studies, repeat sleep studies, cpap, use surgery when appropriate, trials of medication and you may also want to prove the existence and severity of your restrictions limitations by testing called CPET testing, which measures basically your fatigue after engaging in activity and is basically you're riding a bicycle, they're measuring your pulmonary function and they're correlating your fatigue levels with your activity levels. That's very expensive but also can be very helpful. Number two could be a functional capacity evaluation test that measures the impact of fatigue on your ability to do basic work functions. And the third might be neuropsychological testing to prove that, and I hate to say this, that you're not crazy. Many times Social Security will say that sleep disorders are all in your head, psychologically based. What's number three? We want to claim additional medical conditions caused by your sleep disorder. Now, I know, representing many folks who have had sleep disorders over my many years of practice, that sleep disorders can cause other serious health conditions that can be disabling, even though the underlying sleep disorder condition may not be disabling.

Nancy Cavey [00:15:52 - 00:17:04]

And these conditions can include heart conditions such as heart attacks, heart disease, heart failure, or irregular heartbeat. You might have a stroke, you might have diabetes, whatever you have in terms of complications or new and additional medical conditions or conditions that we want to add as the basis of your claim. And I think that it's crucial that you're talking with an experienced Social Security disability attorney who's going to review your medical records before you stop work to help you formulate a strategy to develop the necessary objective testing of the underlying sleep apnea, but the objective testing of other medical conditions, which in and of themselves could be disabling. Number four, argue that a combination of conditions is disabling. Now, I have cases where people will say, well, you know, it really is my sleep apnea that's disabling me, when in fact they have heart conditions. I want to argue each one of these conditions individually, the sleep disorder condition and either the side effect, the cardiac condition or an independent disabling medical condition. And then I want to put them in a pot. So what do I mean here? Your sleep apnea may cause you extreme fatigue, headaches and cognitive issues.

Nancy Cavey [00:17:05 - 00:17:45]

Your heart condition might limit your ability to sit, stand. The need to elevate your legs, might even cause shortness of breath. And we're going to argue each individually, but then we want to argue that it's the interaction of these disabling conditions that would qualify you for your benefits. Number five, I think this is a two part recommendation. Number one, you giving a fantastic medical history of your symptoms and functionality and having your physician support your claim with a residual functional capacity forms. So let's talk about this. I think that you should be giving an accurate and complete statement of your symptoms, every one of your sleep apnea symptoms. 1, 2, 3, 4, 5.

Nancy Cavey [00:17:45 - 00:19:07]

Draw a line, if you will, on a piece of paper across each one of these symptoms and talk about where those symptoms occur, how long those symptoms last, how often you have them and give an example of the functioning problems you have both physically and cognitively. Then do that with any other medical conditions that could be either a side effect of the sleep apnea or an independent one. So you're going to be making lists of symptoms and functionality, and you're going to be taking those to your doctor to ask your doctor to incorporate those in your medical records. Why is that important? If your medical records don't address basic functional activity, how long you can sit, stand, walk, steam or lift, whether you have problems with concentration, pace or attendance, the Social Security Administration is going to default and say you might be able to perform your past work if it's, you know, light work. Or, you know, you could actually do sedentary work at step five, like sorting nuts and bolts or addressing envelopes or other stupid kind of work. It is really important, therefore, that your doctor is addressing your functional restrictions and limitations the way that we Social Security lawyers do that are through residual functional capacity forms that we've created. We have them for sleep disorders. If you have complications, if you've had a stroke, if you have diabetes, if you have a heart condition, we're going to give you these additional residual functional capacity forms and ask you to have your doctors complete them all.

Nancy Cavey [00:19:07 - 00:20:12]

Why? We need to document objectively your functional, physical and cognitive restrictions and limitations to prove objective. Either you meet a listing at step three or you cannot go back to your past work at step four and at step five, you can't do other work in the mythical, hypothetical, not real world national economy. And of course, if you're over 50, we've got two ways to win that crazy cockamamie test and the grid test. But in either event, your functional, physical and cognitive restrictions and limitations are important. They're important at step three, three at step four, and step five so you can improve your chances of winning your Social Security disability case by having your doctor complete a residual functional capacity form. And with those five tips, I think you've got a good chance of winning your case. But I'm going to add a bonus tip. If, for example, you have had problems at work observed by a former supervisor or a former co worker, you might want to ask them to write out a statement that explains the physical and cognitive difficulties you have.

Nancy Cavey [00:20:12 - 00:21:15]

Have them sign it, have that statement notarized, and you want to add that and submit it to the Social Security administration so that they can see that it's a disinterested person, not your spouse or somebody else who is writing this third party function report. Obviously, third party function reports are important, but I think supplementing that kind of information with somebody who's observed you in the workplace can also be the key to getting your Social Security disability benefits for sleep disorder. Now, that's it for this episode of Winning Isn't Easy. I hope you found this episode helpful. Please take a moment to like our page, leave a review, share it with family and friends, and subscribe to this podcast. Join us next week for another insightful episode of Winning Isn't Easy, the Social Security Edition. Thanks for listening, Sam.